2014 Barclay and Barclay vs. 2015 Mischoulon Studies of Depression. More recent double-
blind research on the use of CES in depression has yielded inconsistent results. Barclay and
Barclay^15 used the Alpha-stim CES device at unspecified dosages of less than 1 mA at 0.5 Hz
and measured baseline and outcome measures at weeks one, three, and five. Response to
treatment was defined as a reduction of ≥50% or more on the two Hamilton Depression
Rating Scale measures. Analysis of covariance revealed a significant difference between the
active CES group and the sham CES group on anxiety (p=0.001, d=0.94) and on depression
(p=0.001, d=0.78) from baseline to endpoint of study in favor of the active CES group.
Mischoulon et al.^16 conducted a shorter and smaller three-week study of subjects with
treatment-resistant major depressive disorder, using the Fisher-Wallace CES device. Devices
were calibrated such that the power knob was to be turned up all the way for the required
dose, and subjects were explicitly told to set the wheel to the maximum level. The controller
(or subject, in the case of a home session) slowly turned up the CES current until the knob
was at the maximum setting. The device's electronic waveform contains a 15,000 Hz square
wave carrier which is rectified, varying from 0 to 4 mA. The first 15 Hz modulating signal (to
theoretically influence brain neurochemical activity) provides 50 ms of “on” time and 16.7
ms of “off” time (total pulse period 66.7 ms, 50% duty cycle). A second, 500 Hz modulating
signal changes the “on” time series of 15,000 Hz carrier pulses (750 pulses in 50 ms) into 25
smaller bursts of 15 pulses each of the 15,000 Hz carrier signal, for 375 pulses in the same 50
ms. The consecutive positive burst and “off” time is followed by an equal and opposite
negative burst and “off” time, balancing the direct current component to zero. Output
voltage ranges from 0 to 40 V, first positive and then negative. CES was left at this level until
it automatically shut off after 20 min. Based on the current strength, subjects receiving
active or sham treatment were not expected to feel any current and were told that they
should feel nothing.
The primary outcome measure of the Mischoulon et al. study was improvement in the 17-
item Hamilton Depression Rating Scale (HAM-D-17). Both treatment groups demonstrated
improvement of about 3e5 points in HAM-D-17 scores (p < 0.05 for both), and no significant