Can headphone and smartphone apps really treat depression? This is what Flow's claim to its medically-approved brain-stimulating headphones, a device that presses your neurons with gentle electrical current and one that you can buy and use in your home.
For more information on major depressive disorders, you can also read more at the charity Mind, the NHS website or WebMD.
Flow is a medical technology company founded in 2016 and is currently based in Sweden. Its CEO, clinical psychologist Daniel Mansson, founded the company after writing his master's thesis on brain stimulation and has years of experience working at the intersection of psychology and software.
We have heard that electric shocks to headphones help you juggle, but can a hardware product really succeed instead of or even begin to help existing medical treatments for depression?
To look at the potential health benefits of a product like this, I spoke with CEO Daniel Manson while handling Flow Flow headphones to gain insight into the hardware on offer.
What is a Flowset Handset?
The Flow Headset heads a bit like a miniature VR headset, except that the curved white visor sits solely on your forehead, with a strap hooked over the top of your head to hold it in place.
The box also comes with a disposable canvas box that fits between the skin and the suction pads on the handset, since your skin is unlikely to respond well to direct electrical currents.
The treatments last for about 30 minutes, "with 18 sessions over a 6 week period" (three times a week) or "as long as needed." The headset is designed to be used in tandem with a virtual therapy application that helps inform users of depression and the types of "lifestyle changes" a patient can make with their diet, exercise regimen, sleep hygiene and meditation (the app is iOS only) .
There is an idea of something a little disturbing in the idea of giving a mild form of shock therapy on its own, but there are existing treatments that use the same underlying technology: transcranial direct current stimulation (or TDCS).
This treatment is a non-invasive way of stimulating the brain with gentle electrical currents, using battery-powered electrodes.
Flow's website states that "People diagnosed with depression often have lower activity in the left anterior cortex of their brain. The headphones deliver a gentle electrical signal that activates neurons and restores activity in the frontal lobe.
"The headset is based on a well-researched brain stimulation technology called transcranial direct current stimulation, which has been shown in clinical studies to reliably improve symptoms of depression."
Hold on, is that a thing?
Claiming to sound a bit sci-fi, the technology has gone through numerous medical tests, with evidence that enough Flow Flow headsets have been approved for medical use in the UK and Europe.
Mansson tells me that Flow is seeking similar medical approval in the US and is talking to the UK National Health Service about getting prescription handsets.
Treatment is listed on the NHS website as a method of treatment, and the National Institute for Excellence in Health and Nursing (NICE) claims "no major safety concerns", although patients should be taken through the risks and side effects associated with it.
We do not strongly advise you no use headphones without a doctor's approval and official diagnosis of major depressive disorders. Anyone with a "pre-existing neurological" condition or with broken skin at the point of contact with the headset should be extra careful.
I was wrong here to take caution – as someone more familiar with anxiety treatments than those used for depression – so I cannot speak about efficacy alone.
However, both British Journal of Psychiatry i New England Journal of Medicine published the results of randomized controlled trials using the type of brain stimulation used in Flowset headsets.
Both of these tests worked with several hundred patients (289 in the first, 245 in the second), with the British Journal of Psychiatry calling the treatment "comparable" to "treatment with antidepressants in primary care".
But the New England Journal of Medicine, in turn, hesitated and reported "more harmful" effects – such as "skin redness, tinnitus and nervousness" […] and new mania ”- with no apparent improvement over other forms of therapy. Another study published by the online journal Brain Stimulation advised the use of patients prone to seizures or epilepsy.
Flow director Daniel Mansson says the company has worked for more than two years "to ensure that all safety standards and good manufacturing practices are met and documented" before receiving its seal of approval in June 2019.
But some skepticism is appropriate, given the inconsistent results of mental health treatments previously available to patients in the UK and Europe.
Depression, despite its prevalence in our society (the World Health Organization estimates an estimated 300 million people living with fitness worldwide), is not really understood very well – and there are a number of different strategies for combating adversity.
Depth psychoanalysis may be recommended to understand the underlying psychological causes, provide cognitive behavioral therapy to address behavioral symptoms, or provide medication as a chemical solution – if not a combination of the three, with varying degrees of success.
Such things may not be recommended when you need them given how severe mental illness can be diagnosed. So, a do-it-yourself solution that you can buy on your own – bypassing lengthy and potentially consulted appointments, even if you are not meant to do so without medical approval – offers convenience in itself.
"The combination of brain stimulation headsets and therapy applications," says Mansson, "creates a new, very powerful but also very safe home treatment solution."
There has been tremendous growth in the types of self-care and meditation applications like HeadSpace, often recommended by GPs in the UK – offering ways to manage stress, pain or anxiety.
Of course, cost becomes a problem when patients are expected to find healthcare solutions outside of the national health services. Flow headsets cost £ 399 (about $ 480 / AU $ 710), at no extra cost – while the HeadSpace app, by comparison, will set you back $ 95 / $ 72 / AU $ 149 for a year of subscription.
Mansson is sure Flow said only one tool "within the treatment tool," but as a commercially available hardware product it has the potential to change the way patients usually treat it, especially if costs are reduced.
“We are currently seeing a shift from pharmacological treatments to more digital therapy-based alternatives,” says Mansson, “which empower patients and motivate them to treat their condition from the comfort of their home.
"Given that brain stimulation devices (if medically approved) offer few side effects and are affordable and affordable, it makes sense that devices like Flow are becoming more and more popular."
So … should I have one?
Well, not with my own bat. The jury is not sympathetic to the effectiveness of tDCS, even if it is slowly gaining more traction as a potential aid for major depressive disorders.
However, with the increasing push towards more digital therapies and care treatments, signs suggest that there will be more treatments like these suggested by medical professionals going forward.
But neither Flow nor I would recommend picking this up on a whim and you really should wait until your doctor recommends it to help you with your specific needs.
For more information, please refer to Flow website.