differences were observed between groups. Remission rates were 12% for CES, and 15% for
sham, a nonsignificant difference. Limitations include a small sample and lack of an active
comparator therapy. Although both treatment groups improved significantly, this CES at the
setting chosen did not separate from sham in this sample. Thus, the study could not rule out
that the benefit from this setting used in this particular form of CES was due to placebo
effects. Since this form of CES has other settings, Mischoulon et al. recommended that future
studies test these other settings and compare the Fisher-Wallace against other CES devices. 2014 Cochrane Review of Depression. An inconclusive 2014 Cochrane Collaboration review^17
concluded that: “There are insufficient methodologically rigorous studies of CES in treatment
of acute depression. There is a need for double-blind randomized controlled trials of CES in
the treatment of acute depression.” The seven existing double-blind studies of the use of CES
to treat depression were disregarded because the authors did not use standardized rating
scales to measure depression and included some subjects with chronic rather than acute
depression, and the sham treatment did not include low-current electrical stimulation
adequate to simulate the “tingling” sometimes experienced with CES.
In a personal communication, Mischoulon suggested that the authors might have “set the
bar too high” with regard to conducting a full analysis of the 270 studies, and that the review
might have been more informative had they attempted to analyze the seven studies to some
degree, so as to give the readership and interested clinicians at least some sense of how to
determine whether CES would be an appropriate choice for certain patients. Mischoulon
also added that since CES uses a low current, it might be difficult to design and implement a
sham intervention that would produce non-therapeutic tingling, that most patients
experience no tingling during CES treatment and that patients that he has observed who
experience tingling do not report different clinical effects, such as a greater improvement,
compared to patients who don’t experience tingling.
The Cochrane review itself proposed to drop the tingling requirement in future reviews and
meta-analyses: “Thus, in future updates, we will continue to specify that included trials use