The tDCS “Cat” is Out of the Bag

Miracle Medication

Aspirin is a miracle medication. Isolated by Hoffman in 1897, it is a simple compound that, these days, can be created by anyone who has had a high-school chemistry course. Aspirin can, of course, be purchased in commercial form and most people are familiar with certain maladies that can be treated by it. On the fringes, there are esoteric uses for aspirin, but in the main, it is well understood and used by millions of people every day.

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What about transcranial direct current stimulation (tDCS)? It’s simpler and (apparently) safer than aspirin – when used correctly – and is effective in treating depression, chronic pain, enhancing learning and much more in otherwise healthy people. So why can’t the average person on the street buy a tDCS device and self-administer treatment?

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(neura.edu.au)

There are at least three reasons. First, tDCS is relatively new and studies that confirm its effectiveness and safety are just emerging. Two, certain tDCS treatment scenarios can be pretty complex, well beyond the ability of an average person to carry out. Third, there is no way for big-pharma to cash in on tDCS (yet). It’s very unlikely you will ever see expensive commercials during your favorite TV show advertising tDCS to treat some focus-group tested three-letter malady. It won’t happen. tDCS devices are extremely simple to build (or buy) and treatment protocols for certain ailments ARE simple and are all over the internet.

The average Joe will learn about tDCS and start demanding access to it because a bunch of do-it-yourself (DIY) folks and a few physicians will have succeeded in a grass-roots effort to get the word out. Yes, there is also a small and growing group of doctors that see the obvious benefits of tDCS (and lack of risk) and are starting to use it with their patients – and their patients are becoming some of the best spokes-persons for tDCS.

Problems, Problems

According to the CDC, about 1 in 10 adults in the US uses some form of antidepressant.  Their depression may or may not be well controlled and they likely suffer at least some noticeable side effects. Sources vary, but about $3 billion is spent on antidepressants every year. These numbers do not reflect a significant number of individuals who ARE depressed but not receiving any treatment – due to costs, social pressures, etc.

It’s hard to believe, but various sources report that as many as 1 in 3 Americans suffer from chronic pain.  Cost? $500-600 billion per year!

The tDCS Triad

Transcranial Direct Current Stimulation has been shown to provide relief for depression and chronic pain, and to enhance learning (the tDCS triad) – and much more. When treating the “triad”, it is simple, apparently very safe, and has no significant side effects. Can similar claims be made for any other other treatment (medication)?

Does it work for everyone? The simple answer is no, but for many it does – and for many who failed to get relief (or enhancement) from medications.

tDCS is not just about depression, chronic pain, and learning enhancement. As mentioned above, there are very broad areas of research seeking potential use in treating Alzheimers, stroke, brain trauma, etc. Treatment for those less understood ailments can be quite complex and require MRI or FMRI to design an appropriate regimen and the use of “high definition” tDCS, using ten electrodes or more, as part of the treatment. This is well beyond the ability of the DIY community.

But the “triad” (depression, chronic pain, learning enhancement) is normally treated with simple “bipolar tDCS” – two electrodes are placed in very specific locations on the scalp, which are well known, as part of normal treatment.

Because bi-polar tDCS involves such simple equipment and procedures, a rather sizable “do-it-yourself” community has taken up the mantle of treating themselves and helping friends reap the benefits of tDCS.

DIY tDCS is growing because most doctors have no idea what tDCS is – or what it can do. Further, doctors who do use tDCS cannot bill insurance for tDCS treatments (it is not yet “recognized” by the FDA.) So treatment can be expensive – out of reach for many – and simply unavailable in most areas of the US. So it seems that the DIY community will continue to build tDCS devices, use tDCS to treat the “triad”, and spread the word via emails and blogs. Meanwhile, research centers, Universities, and the like will continue their work on all areas of tDCS using their more sophisticated equipment and techniques to push the boundaries of tDCS application.

tDCS for Everyone?

One day, tDCS may be as commonly used as aspirin for treating certain issues – but we have a long, long way to go to get to that point. Like aspirin, tDCS won’t help everyone – but scientific and anecdotal evidence says it can help many. So while we wait, millions go untreated (or poorly-treated) and live lesser lives due to lack of access to tDCS triad treatments and all the benefits they can bring. Come on medical community, come on FDA.

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12 comments on “The tDCS “Cat” is Out of the Bag

  1. I agree the potential for tDCS for regular use by the population at large is very exciting: safe, easy, and very broad physiological functions.

    In addition to the lack of regulation and the lack of incentive from the medical industry, I think there is a societal block that needs to be overcome. Nearly every media article has a “don’t do this at home” slant to it. But as early adopters become an even larger group it there will definitely cause some pressure.

    It would be nice if there was some FDA exception, as is done with supplements, for tdcs, but I don’t think that will happen.

  2. Just a few days ago I emailed Neuroelectrics about their Starstim 8-channel wireless tDCS system, and asked them if I could buy one. They emailed back and said that (1) it’s only available to researchers/clinicians/physicians etc, (2) that they believed that the tDCS is a medical ONLY treatment, and (3) that there were not enough studies to justify making it available to the average joe. I emailed back and told them that I was no average joe, that I had done my homework and felt confident in experimenting on my own brain following exact lab protocols and montages. I also asked how they came to the conclusion/belief that tDCS was only a medical treatment when it has applications outside of medicine? (e.g., learning enhancement, contemplative/meditative facilitation, etc). I said that that was like saying that gym equipment should only be used for sports rehabilitation but not for maintaining or improving health, strength, or endurance. They didnt email me back.

    • Your post, JD, demonstrates the ignorance so often seen in the tDCS DIY literature. You don’t think that brain stimulation is a medical procedure? Regardless of the effects that you are trying to achieve, you are stimulating the brain with electricity. Extrapolating your logic, ECT, if not used to treat depression, wouldn’t be a medical procedure? Similarly, you gym equipment analogy is ridiculous, comparable to Fox News logic. Maybe that’s why you didn’t get a response from the manufacturer.

      If you want to have a serious discussion about individual use of tDCS, the bottom line is that you need to have an adequate supervision plan, otherwise you’ll have the same problems which occur with self-medication with prescription drugs. tDCS is not comparable to supplement or OTC drug use or exercise equipment. tDCS is comparable to prescription drug use. If you cannot comprehend that, how can you think that you’re competent to self-administer tDCS?

      I would like to see tDCS become more available for home use. This requires accessible and competent supervision.

      • @Fudedy

        No, I dont think that it’s a medical ONLY procedure. The most obvious reason being that it can be used for non-medical purposes. What you’re looking at is essentially a device for altering brain-function/consciousness that has multiple applications, medicine being one of them. So who is are the group of control freaks who decide for all of us that it’s a medical ONLY instrument and that only certain people can have access to “safe” or good quality devices?

        I think the gym equipment analogy works fine to show that tools/devices that have non-medical uses can be mislabeled as medical-only devices, and that this is really just a misdirect intended to control who gets access and who doesn’t.

        As for ECT, it does not appear to have non-medical potential, and it’s not as safe as tDCS, so cannot be compared on the same level with tDCS.

      • As for requiring supervision to use tDCS the technology, I think that’s bs. You’re only saying this because this is what you do for your work, and if more people started to do it themselves, then they wouldnt need your suprvision. Not saying that everyone can do without supervision, but a lot can definitely perform the necessary procedures without any supervision. And if you look at it clearly, you’ll find that people routinely engage in activities that are far more dangerous than passing 1-2mA of current transcranially. If done properly, with the right information, tDCS is no more dangerous than driving a car. Besides, who are these idiots who think they can tell us what we can and cant do with our own brains? They think theyre protecting society by witholding access to good quality devices? pfft.

      • “You don’t think that brain stimulation is a medical procedure? Regardless of the effects that you are trying to achieve, you are stimulating the brain with electricity.”

        Stimulating the brain with minute currents of electricity does not automatically make it a medical practice. tDCS has many applications, and medicine is just one of them. In addition, it’s also a very safe technology to utilize according to the scientific literature. Therefore, it doesn’t help to try to define it as ‘medical ONLY’ tool, to be exclusively used by medical ONLY people. Just as stimulating ourselves with light and sound (e.g., movies, video games,) doesn’t belong to medicine, even though light and sound has been shown to have health benefits. Besides, I’m stimulating MY brain with electricity, not your brain.

        You seem to have missed the point of the analogy I used. It was simply to point out that a tool or method can have applications outside of medicine, and so it makes little sense to define such a tool exclusively as a medical device. And I think the real reason I didn’t get a response from neuroelectrics was because they had nothing to say in response to this point.

        “If you want to have a serious discussion about individual use of tDCS, the bottom line is that you need to have an adequate supervision plan, otherwise you’ll have the same problems which occur with self-medication with prescription drugs.”

        Hardly. Self-medicating with prescription drugs is a much more complicated and potentially dangerous affair than applying a 1-2mA current at home, because there are many types of drugs and they all do different things in different quantities depending on who is using them. So self-medicating drugs is nothing like using tDCS at home. But you already know this, because you’ve got your own patients doing tDCS at home. So I strikes me as odd to find you here suddenly speaking as if it’s dangerous and requires supervision. Perhaps in some cases it does require supervision, and that’s fine. But not everyone requires supervision to execute their own tDCS procedure. So why are we seeing all these unnecessary, control-freak, red tape restrictions being put up around tDCS access?

  3. FYI:

    J Med Ethics. 2013 Jun 3.
    The challenge of crafting policy for do-it-yourself brain stimulation.
    Fitz NS, Reiner PB.
    Source
    National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia, Canada.
    Abstract
    Transcranial direct current stimulation (tDCS), a simple means of brain stimulation, possesses a trifecta of appealing features: it is relatively safe, relatively inexpensive and relatively effective. It is also relatively easy to obtain a device and the do-it-yourself (DIY) community has become galvanised by reports that tDCS can be used as an all-purpose cognitive enhancer. We provide practical recommendations designed to guide balanced discourse, propagate norms of safe use and stimulate dialogue between the DIY community and regulatory authorities. We call on all stakeholders-regulators, scientists and the DIY community-to share in crafting policy proposals that ensure public safety while supporting DIY innovation.

    COMPLETE ARTICLE:
    http://jme.bmj.com/content/early/2013/05/20/medethics-2013-101458.full.pdf+html

      • Finally got around to reading through the medethics paper, and then, ended up annotating half of it with some of my own thoughts and perspectives! The paper raises some minor concerns, but fails to substantiate them. Actually, all of the concerns raised by the techno-phobe community are easily addressed using applied logic. Have a read –> http://tinyurl.com/lqvat4n (must ‘download’ to see annotations.)

  4. “So why are we seeing all these unnecessary, control-freak, red tape restrictions being put up around tDCS access?”

    Here’s why:

    TDCS is safe, cost effective, non-invasive, easy to use, and it’ll result in pharmaceutical companies losing billions of dollars, because people won’t need to rely so much on their junky concoctions.

  5. I have been following the research on tcds for almost a year now. I have a compilation of 48 separate articles, many of which are small studies, some are medium size studies, some are informative reviews and two are meta-reviews of practice. I’ve noticed that a lot of blog’s posts (like doctorfudgety) seem to eminate a qualified response without actually being an informed researcher about it. (exhaustive, not brief “proofs”) Others, understandably very eager to try it, still do not follow through with ongoing research and critical analysis before wanting to jump in. All said, many good points are made by both sides. The key theme to remember is that it is being newly researched. A lot of questions are still unanswered. For example; there have been many studies that claim, and through their design, prove very little risk. The problem with those studies is that most of them consist of application and testing, with some follow-up interviewing rarely more than several months later. What about consistant use over several years? what about higher than the accepted practice of no more than 2.0mA, What about longer periods of time than the accepted 30-60 minute application? Are you aware of a meta-review that tests medications and thier effect on tcds therapy? If there is ANY effect of a medication upon the results of tcds therapy, (remember, ultimately we are talking about YOUR brain function) Then what may that tell you of the reverse logic? (does tcds alter the effects of important medications like antidepressants, dopamine upregulators, stimulants like Adderal, and or psychotropic drugs?) Have patience, research a lot, and dont stop, some information may come through that would either clear the way for you, or save you some costly or tragic problems. In terms of valid research (from the scientist’s point of view), many tests consisting of hundreds to several thousands of subjects with varying qualifications have to be made and reviewed before any therapy or medicine is considered a success or failure. Because tcds is so cheaply available (anyone with rudimentary electronics skill can assemble a small current regulating diode mechanism for delivery of tcds), there isn’t a lot of sponsored research money available. However, if enough people were interested, a grass-roots support and or approach may be used.. In this day of distributed computing, kickstarters, Article-One (a distributive network of awarded patent researchers), etc, there should be a way of funding and directing research on no or low profit medical or other-wise theraputic devices and or procedures to benefit the people at large despite the heavy handed control of a profit margin that uses adjudication and legislation to bully it’s views upon everone else (other than the real efforts of safety-mindedness, of course).

  6. tDCS is an emerging technology with enormous and ground-breaking potential in the mental health field, as cognitive enhancement, and for contemplative-spiritual purposes. But in order to justify the high cost of the most advanced devices (such as Starstim), a great deal more research must be done. Companies are understandably nervous about reckless experimentation by DIYers, especially if they are otherwise healthy people seeking only to boost their smarts or reaction time. (Not to mention, JD, that Neuroelectrics can’t legally sell you their product anyway.).

    The good news is that, given the speed with which these devices are advancing, it will only be a matter of perhaps a decade until sophisticated tDCS devices are available for home use at a fraction of the cost they are now, with a range of proven treatment options far exceeding what they currently possess.

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