"The noninvasive techniques involve the transcranial application of electrical (direct or alternating) or magnetic fields to the scalp at subconvulsive levels. These interventions include repetitive transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and cranial electric stimulation (CES). Given the absence of an induced seizure, these interventions are hypothesized to act through plastic effects exerted by the repeated electrical stimulation of cortical circuits (in the case of alternating currents), or via potentiation of endogenous firing (in the case of direct currents)."
"CES also called transcranial electrostimulation (Boutros and Krupitsky, 1998) is perhaps the oldest way of stimulating the brain noninvasively (Figure 2). It includes a variety of different techniques that have in common the use of low-level alternating electrical (low current amplitude) signals applied to the scalp or earlobes (Klawansky et al, 1995). Although tDCS can be considered a form of CES, it was treated separately because there are data suggesting that its effects are quite different in the brain physiological effects (Stagg and Nitsche, 2011). There is also a ‘mixed' form of CES in which constant electric current (similar to tDCS) is combined with pulses of alternating current. This form of stimulation was used in Russia especially for narcoanalgesia (Boutros and Krupitsky, 1998)."
Cranial Electrotherapy Stimulation (CES) is a non-invasive, FDA-cleared treatment that delivers low-level, pulsed electrical currents—usually below 1 milliampere—via electrodes attached to the earlobes, mastoid processes, or temples. It's primarily used for anxiety, depression, insomnia, and occasionally for pain and substance withdrawal.
🧠How It Works (Mechanism of Action)
The exact mechanism isn't fully understood, but CES is thought to work through several neurobiological processes:
Neurotransmitter Modulation
CES appears to affect levels of serotonin, dopamine, norepinephrine, and beta-endorphins, which are key players in mood regulation and pain perception. It may increase availability or balance of these chemicals.
Thalamic and Brainstem Modulation
CES may normalize activity in the thalamus and brainstem reticular formation, which are areas involved in arousal, attention, and sleep-wake cycles. This helps explain its use for insomnia and anxiety.
Alpha Brainwave Stimulation
CES has been shown to increase alpha brainwave activity, often associated with relaxed alertness. This can counteract overactive beta-wave patterns seen in anxiety and hypervigilance.
Autonomic Nervous System Balancing
Some studies suggest CES shifts the autonomic nervous system toward parasympathetic dominance, promoting relaxation and reducing sympathetic “fight or flight” activity.
⚙️ What Devices Are Used?
- Alpha-Stim (most widely known)
- Fisher Wallace Stimulator
- CES Ultra
These are portable, often battery-operated, and typically used for 20–60 minutes per day.
✅ Conditions with Supportive Evidence
- Anxiety Disorders (GAD, panic)
- Depression (especially mild to moderate)
- Insomnia
- PTSD (some studies support use as an adjunct)
- Chronic pain (like fibromyalgia, but more mixed evidence)
⚠️ Contraindications & Side Effects
Not recommended for people with implanted electronic devices (like pacemakers).
Side effects are usually mild: headache, dizziness, skin irritation, or sleepiness.
Not ideal as a standalone treatment for severe depression or suicidality.
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Jane Leu Rekas, LCSW
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