A few years ago, I suffered a nasty concussion while surfing in Bali, Indonesia. What was supposed to be a week-long recovery period, slowly morphed into a six-month journey of healing. If you’re unfamiliar with traumatic brain injuries, it can come with a slew of physical, mental and emotional challenges.
Within days of getting my head rocked by my surfboard, I started experiencing headaches, dizziness, mental fatigue, and sensitivity to light and noise. Most of my days were spent laying silently in bed with earplugs jammed in my ears and blindfolds over my eyes. Things like television, music, internet, and even time with friends and family all had to be removed from my life, as it was all too much for my brain to handle.
Without these comforts in my life, my mood worsened after each week that passed. I started experiencing severe bouts of insomnia, anxiety, and depression. Ironically, mood has a massive impact on brain healing. I eventually found myself in a downward spiral from hell. As my mood worsened, my concussion recovery stalled, which only worsened my mood even more.
In order to break out of this loop, I decided to take antidepressant medication (20 mg daily of Fluoxetine, otherwise known as Prozac). This turned out to be one of the best decisions I could have made. Within weeks, my depression went away and my brain finally started to heal. After six months, I was finally back on my feet.
Yet as amazing as it was to be healed, my goal was to eventually get off the meds. Side effects like low libido and emotional numbness were making antidepressant medication less appealing. I turned to a number of tools to help ramp off them, such as psychedelics, brainwave entrainment, and meditation. Of the tools I’ve taken to help manage my depression and anxiety, transcranial direct current stimulation (tDCS) has been the most impactful.
If you’ve never heard of this technology, it’s a form of brain stimulation (otherwise known as neuromodulation). The practice involves applying some form of energy to the brain to affect its functioning in a positive way. This could be in the form of magnetism, light, or ultrasound. In the case of tDCS, it uses weak electrical signals.
Using my favorite tDCS device, the Activa Dose II.
Over the past few years, tDCS has been getting a lot of attention in the media, with a wide spectrum of opinions around this emerging technology. Fanatics say tDCS is the be-all, end-all silver bullet to hack the mind. Skeptics quickly label it as a dangerous tool that could lead to long-term brain damage. Like most things, the truth sits somewhere in the middle. In this article, I’d like to explore transcranial direct current stimulation to manage depression and anxiety.
This article is the result of over a year of experimenting with tDCS, and picking the brains of the most authoritative researchers and clinicians that specialize in the technology.
Before we begin, it’s worth stressing that I’m a not a doctor and everything I’m about to talk about shouldn’t be taken as medical advice. As always, consult a health professional before trying out any new form of therapy such as tDCS. Do your homework and make an informed decision if this is for you.
With that disclaimer out of the way, let’s get started.
What is transcranial direct current stimulation (tDCS)?
As mentioned, electrical brain stimulation has been getting a lot of media attention as of late. DARPA uses it increase learning speed up to 40%, Olympic athletes have turned to it to improve performance, it’s even been shown to reduce the desire to carry out physical and sexual assault.
There are two forms of electrical brain stimulation. The first is an invasive procedure involving surgery where an electrode is inserted deep inside the brain. This can be looked at like a pacemaker for the brain and often used to manage neurodegenerative diseases such as Parkinson’s (for more information on deep brain stimulation, check Warrior Radio Episode 5 : Upgrading The Mind Using Brain Stimulation Technology – with Dr. Jay Sanguinetti)
The other form of electrical brain stimulation is non-invasive, which transcranial direct current stimulation (tDCS) falls under. This involves placing a cap or individual electrodes to specific areas of the scalp, which applies a low level of electricity through the skin to eventually get to the brain. These devices are powered by either a 9-volt battery or an electrical stimulator.
How does tDCS work?
Although most neuroscientists will admit there are a mountain of questions as to how the brain works, the scientific community has discovered a great deal about how tDCS affects brain function.
The brain is made up of approximately 100 billion neurons, and trillions of connections between them. This immense neural network is responsible for anything and everything related to your reality. From your thoughts to your emotions, to all functions of your body – it’s all driven by electrical signals flowing from one neuron to the next throughout the brain’s neural web.
These electrical signals flow through the brain through charged ions (which are either negatively or positively charged). Fatty membranes surround the neuron’s cell, preventing most things from entering it. However, these membranes are also made of ion channels, allowing charged ions to travel in and out.
When we place electrodes on our scalp, electricity is sent to our head. Some of that current eventually makes its way to the brain. Most of this current passes around neurons, but a portion of the electrical current travels through the cell’s membrane and into the neuron itself. This alters the ion concentration between the inside and outside of the neuron, which changes its firing rate. For a more in-depth explanation of the science behind tDCS, here’s a clip of my interview with brain stimulation expert Dr. James Fugedy:
By altering the neuron’s firing rate, you change how it works. tDCS allows you to target specific areas of the brain, essentially winding it up (or down) in the process.
So how does this relate to depression management?
How does tDCS treat depression and anxiety?
The short answer is we don’t fully know. Depression is a complex topic, and the medical community is still scratching uncovering the science and treatment of depression. Every person is different, every brain is different, and a solution that is effective for one person may not be for another. However, there are a few key insights researchers have learned about depression and brain stimulation.
People with chronic depression tend to have a different brain activity than those without, specifically in the brain’s left dorsolateral prefrontal cortex, which helps to manage our mood. Studies have found that depressed people tend to have less activity in this area compared to the right.1 Researchers studying Tibetan monks have even found a correlation between the monk’s expert level and the activity levels of the left dorsolateral prefrontal cortex.2
Transcranial direct current stimulation is able to target and enhance the activity of the brain’s left frontal lobe, allowing it to behave more like a happy person. A mountain of clinical trials evaluating tDCS against sham or placebo solutions has backed up this conclusion. In researching this article, I found over 14,000 results on Google Scholar relating to tDCS and depression.
One notable study was from the University of New South Wales in Australia lead by professor Colleen Loo published in 2012. To date, it gathered the largest sample of depressed patients for a double-blind, sham-controlled trial of tDCS.3
Sixty-four individuals suffering from depression received either an active or sham tDCS session targeting the left prefrontal cortex using 2 milliamps of electricity. The study ran 15 sessions over 3 weeks, followed by another 3-week open-label active treatment session phase. It confirmed earlier studies, finding active tDCS sessions lead to a significantly greater improvement in mood compared to sham treatments. In fact, they found that on average, participants saw roughly about 10% reduction in depressive symptoms per week of treatment:
With all that said, every person is different, and every brain is different. tDCS is not a silver bullet that will magically work for all people in all scenarios. What works for one person, may give the opposite results for another. Dr. Vince Clark recently spoke about this with me:
“It seems like there’s some fundamental differences in the brain’s of depressed people that if you did the same thing to someone who wasn’t depressed, it would actually make them more depressed. The same protocol can make a happy person depressed, and a depressed person happy. It’s more complicated than saying everyone’s brain is the same, and if you do the same thing to each person’s brain, it makes them all happier. It’s not like that at all.”
Is tDCS Safe?
By now, a few red flags might be going off in your head. The idea of shocking yourself might bring back memories of the robbers from Home Alone getting electrocuted by Macaulay Culkin:
But fear not, tDCS is extremely safe. In reality, around 2 milliamps are generated through a 9-volt battery, which is about 1/500th the power of a 100 watt light bulb. The scientific and medical community are at consensus that tDCS is considered safe enough to use in academic labs across the world, under the NIEHS Institutional Review Board (IRB). The IRB have concluded that tDCS is considered a non-significant risk. Meaning you’d have just as much chance of being injured driving the university lab, than you would taking part in the tDCS experiment itself.
That’s not to say that tDCS doesn’t come with its own set of risks (although they’re minor). One of the most common of all tDCS experts have told me is skin irritation. If the current used is above the recommended levels of 0.5 – 2.0 milliamps, you could have serious burns (or even scarring). But these risks can be mitigated by sticking to the recommended tDCS protocols, which we’ll talk about later in this article.
When you weight out the costs and benefits against each other, the arguments for using tDCS to improve your mental health become compelling. I recently spoke to brain stimulation expert Professor Marom Bikson about this, which you can listen here:
What’s the best tDCS device for depression and anxiety?
From the tDCS experts I interviewed, one of thing they unanimously stressed was the importance of using the right device, setting it up the right way, and employing a protocol backed by a randomized, placebo-controlled study. The biggest mistake newbies make is dropping the ball with the tDCS instrument and method. There’s a host of biohacking blogs and YouTube channels using DIY tDCS devices that make most experts cringe. Dr. Marom Bikson recently spoke about these DIY devices with me:
“Without a doubt, it’s possible to make consumer devices that meet a higher standard, and it’s possible to make devices that meet no standard. I would encourage people to do their research, and try to find devices that meet that higher standard, which basically means that the device will deliver a certain amount of current (2 milliamps for 20 minutes) and not burn you. That’s it. We’re setting a pretty low bar. You want that, and yet if something is made is someone’s garage without any sense of quality control, attention to detail, it’s possible to get a device that doesn’t even do that.”
So what’s a quality device that you can trust? The experts recommend going with the Activa Dose II Starter Kit, which runs for about $350. It’s the cheapest, FDA approved tDCS device that’s available on the market right now. As Dr. Vince Clark mentioned to me, “Looking for FDA approval is not always a guarantee, but it’s good evidence that someone has looked at it really closely and verified it works the way that it’s supposed to.”
If you’re interested in getting the ActivaDose II, I recommend you pick up at Capturon.com, the leading distributor of clinical, research and home neurostimulation devices. They were awesome enough to send me the device to help research for this article.
How to use tDCS to manage depression and anxiety
Now that you have a better understanding behind the science of transcranial direct current stimulation and its ability to treat depression, how do you actually put it into practice?
The experts I interviewed all made it clear to follow the most researched tDCS protocols from previous studies. The University of New South Wales study by Colleen Loo I mentioned earlier is a fantastic protocol to follow. If you want a quick and dirty version of it without having to sift through all the academic jargon, I’ll lay out exactly what you need to do.
If you research tDCS protocols, you’ll often hear the term “montage”, which refers to the position of electrodes placed on the head for a particular effect. These positions are based off the 10-20 system, which is an internationally recognized method to position electrodes, regardless of head size and equipment used.
Each point on the above figure reflects a specific point to place an electrode. These points are designated with two characters. The first is a letter that specifies the lobe of the brain:
- F = Frontal
- T = Temporal
- C = Central
- P = Parietal
- O = Occipital
The second character is either a number or a letter. Even numbers refer to the right hemisphere of the brain, and odd numbers refer to the left hemisphere. Z refers to the midline of the scalp. So the point F3 refers to placing the electrode on the frontal cortex, on the left hemisphere.
You’ll see that tDCS devices come with two electrodes, one red and the other black. The red electrode is positively charged and the black electrode is negatively charged.
The tried and true montage for treating depression (typically referred to as the bifrontal montage) places the anode electrode over location F3 (the left dorsolateral prefrontal cortex) and the cathode a few centimeters above the right eyebrow (just below the hairline). The great thing about the Activa Dose II Starter Kit is it comes with a head strap which makes placing these electrodes a breeze.
The clinical trials using tDCS to treat depression had 20-30 minute sessions, usually once a day. I wouldn’t recommend going beyond this range, as there simply hasn’t been enough research showing efficacy or safety.
tDCS is an incredible alternative to help treat depression and anxiety. It helped me get off Prozac, something I relied on to manage my mood after my surf concussion. Follow the guidelines in this article, and you’ll minimize risk involved with the technology, and maximize the incredible, mood-boosting benefits it can offer (2 milliamp 20-minute sessions, no more than once a day).
Have you tried transcranial direct current stimulation to improve your mental health? Let us know about your experience in the comments below.
Cover art by Seamless
Recommended tDCS Books
Online tDCS Communities
Warrior Radio Podcast Episodes related to tDCS
tDCS Instructional Sites
- Electrode Positioning and Montage in Transcranial Direct Current Stimulation
- A technical guide to tDCS, and related non-invasive brain stimulation tools.
In-Person tDCS Training & Workshops:
Recommended tDCS Devices
- Koenigs, Michael, and Jordan Grafman. “The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex.” Behavioural brain research201.2 (2009): 239-243.
- Lutz, Antoine, et al. “Attention regulation and monitoring in meditation.” Trends in cognitive sciences 12.4 (2008): 163-169.
- Loo, Colleen K., et al. “Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial.” The British Journal of Psychiatry 200.1 (2012): 52-59.