Electric Brain Stimulation
Outpatient Electric Stimulation
At Brain Hope Clinic in Del Mar, we offer cutting-edge, non-invasive electric brain stimulation therapies for people seeking relief from depression, anxiety, insomnia, migraines, chronic pain, ADHD, and more. These safe and effective treatments use gentle electrical currents to help balance brain function—without medication or anesthesia.
While the term “brain stimulation” may bring to mind outdated treatments like electroconvulsive therapy (ECT), the therapies we use are completely different—gentle, safe, and non-invasive. Unlike ECT, which uses high-voltage currents and requires anesthesia, our electric stimulation techniques use tiny currents—500 times smaller—with no sedation needed. You stay awake, alert, and can drive yourself to and from sessions. In fact, while ECT may impair memory, many of our patients report enhanced focus, clarity, and memory as their symptoms improve.
Types of Electrical Stimulation
At Brain Hope Clinic, we offer a range of non-invasive electric stimulation therapies that gently activate the brain and/or nervous system. Each therapy is tailored to support emotional balance, reduce pain, and enhance brain and nervous system function—without medication or sedation.
tDCS
Transcranial Direct Current Stimulation
What it is: A low-level direct current applied through scalp electrodes.
What it helps: Depression, ADHD, PTSD, fibromyalgia, chronic pain, and cognitive enhancement.
FDA status: Off-label, with strong research support.
How it feels: A mild tingling on the scalp—painless and relaxing.
Used by: Clinics, athletes, military, and cognitive trainers.
CES
Cranial Electrotherapy Stimulation
What it is: A gentle, alternating current applied via ear clips or electrodes.
What it helps: Anxiety, insomnia, depression, stress, PTSD.
FDA status: FDA-cleared for anxiety, insomnia, and depression.
Popular devices: CES Ultra™, Fisher Wallace Stimulator®.
How it feels: A gentle pulsing or light tapping sensation.
tTNS
Trigeminal Nerve Stimulation
What it is: Targets branches of the trigeminal nerve through surface electrodes on the forehead or face.
What it helps: Pediatric ADHD, depression, PTSD, fibromyalgia.
FDA status: FDA-cleared for ADHD in children ages 7–12.
How it works: Modulates deep brain regions through facial nerve pathways.
tVNS
Transcutaneous Vagus Nerve Stimulation
What it is: Stimulation of the vagus nerve through the ear or neck.
What it helps: Migraines, epilepsy, opioid withdrawal, IBS, mood regulation, and cardiac conditions.
FDA status: FDA-cleared for migraines, epilepsy, and opioid withdrawal.
Bonus: Offers many benefits of implanted VNS without surgery.
TENS Transcutaneous Electrical Nerve Stimulation
What it is: Low-voltage pulses that stimulate nerves to reduce pain.
What it helps: Muscle tension, back pain, fibromyalgia, arthritis.
FDA status: FDA-cleared for pain relief.
Used in: Physical therapy, chronic pain clinics, at-home care.
Light Therapy
Phototherapy
Not Electric Stimulation
What it is: Exposure to specific intensities of bright light, often used during morning sessions.
What it helps: Seasonal Affective Disorder (SAD), PMDD, sleep regulation, energy, and mood.
FDA status: Not FDA-regulated as a medical device, but widely recommended by clinicians.
Conditions Treated with Electric Stimulation
Electric stimulation therapies like tDCS, CES, tVNS, and TENS are safe, research-backed, and often drug-free ways to support brain and body wellness. These treatments work by gently activating or calming specific nerve pathways—and are especially helpful for those who don’t respond well to medications. Some therapies (like CES for anxiety/insomnia or tVNS for migraine) are FDA-cleared, while others are widely used off-label with strong research support.
Depression
FDA-cleared (CES) and off-label (tDCS) – Supports mood regulation by stimulating prefrontal areas. Especially helpful for those sensitive to medication.
(Brunoni et al., 2013; Kirsch & Nichols, 2013)
Anxiety
& Stress
FDA-cleared (CES) – Reduces physical symptoms like muscle tension and racing thoughts. tVNS and tDCS also help regulate the stress response system.
(Feusner et al., 2012; George et al., 2007)
ADHD (Children & Adults)
Off-label (tDCS, tTNS) – Enhances attention, reduces impulsivity, and improves executive function. tTNS is FDA-cleared for children aged 7–12.
(McGough et al., 2019; Soff et al., 2017)
PTSD & Trauma-Related Symptoms
Off-label (tDCS, CES, tVNS) – Calms hyperarousal and supports emotion regulation without medication.
(Clark et al., 2015; George et al., 2014)
Insomnia & Sleep Disturbances
FDA-cleared (CES) – Helps improve sleep onset and quality by promoting calm, balanced brain rhythms.
(Kirsch et al., 1996; Lande et al., 2010)
Cognitive Enhancement (Healthy & Clinical)
Off-label (tDCS) – Enhances memory, attention, and learning in both healthy adults and those with cognitive decline.
(Meinzer et al., 2015; Kuo et al., 2014)
Dementia & Cognitive Decline
Off-label (tDCS, tVNS) – Electric stimulation may help slow cognitive decline.
(Meinzer 2015; Sandrini 2014; Kuo 2014; Babiloni 2014; Elder 2015)
Chronic Pain
Off-label (tDCS, TENS, tVNS) – Helps reduce pain perception and improve mobility in conditions like fibromyalgia, back pain, and neuropathy.
(Fregni et al., 2006; Nitsche et al., 2009)
Fibromyalgia
Off-label (tDCS, TENS) – Reduces pain sensitivity, fatigue, and brain fog by targeting pain-processing circuits.
(Fregni et al., 2006; Lefaucheur et al., 2008)
Migraine & Headaches
FDA-cleared (tVNS) – Decreases frequency and severity of migraines by modulating nerve signals.
(Goadsby et al., 2018; Straube et al., 2015)
Irritable Bowel Syndrome (IBS)
Off-label (tVNS) – May help reduce gut inflammation and stress-driven flares by regulating the gut-brain axis.
(Bonaz et al., 2016)
Opioid Withdrawal Support
FDA-cleared (tVNS) – Helps reduce withdrawal symptoms and cravings through safe nerve stimulation.
(Hein et al., 2013; Gurel et al., 2020)
While the conditions listed above are among the most well-established, electric brain stimulation is not limited to these alone. Research has shown promising results across a wide range of other disorders, including autism spectrum disorder, auditory hallucinations, cerebral palsy, post-stroke aphasia, eating disorders, obsessive-compulsive disorder (OCD), traumatic brain injury, myofascial pain syndrome, and fatigue associated with multiple sclerosis. With more than 3,800 scientific publications on tDCS alone, and growing clinical use of tVNS, CES, and tTNS, these therapies continue to expand their role in mental health and neurological care. At Brain Hope Clinic, we stay informed of this evolving research to offer innovative, evidence-based care tailored to each individual.
Cranial Electrotherapy Stimulation (CES)
transcranial Alternating Current Stimulation (tACS)
Transcranial Alternating Current Stimulation (tACS) and Cranial Electrotherapy Stimulation (CES) are non-invasive methods of brain stimulation that have been used since the 1950s. These therapies apply a gentle, rhythmic electrical current to help balance brain activity and restore natural rhythms—especially in individuals struggling with anxiety, depression, chronic pain, and insomnia.
FDA-Approved Since the 1970s
CES devices were granted Class III medical device status through a pre-amendment pathway (510[k]), meaning they were legally recognized before stricter regulations took effect. They are FDA-cleared for the treatment of insomnia, anxiety, and depression.
How It Works
CES and tACS work by applying low-frequency electrical stimulation to the scalp or earlobes. The rhythmic current encourages natural brainwave patterns, helping reduce overactivity in anxiety and boost underactive circuits in depression or fatigue.
Research-Backed Benefits
According to clinical observations, up to 70% of patients may experience significant relief—often a 50–100% reduction in symptoms like:
• Persistent worry and muscle tension
• Trouble falling or staying asleep
• Chronic, treatment-resistant pain
• Low mood and lack of energy
Devices We Recommend
We’ve seen consistent results with:
• Fisher Wallace Stimulator®
• CES Ultra™
While devices like Alpha-Stim are widely marketed, our clinic has not observed clear advantages over the more affordable and effective CES Ultra or Fisher Wallace units.
What It Feels Like
Treatments are painless and usually feel like a light tapping or tingling. Sessions can be done in-office or at homeusing portable devices with preset programs.
Cranial Electrotherapy Stimulation (CES)
Transcranial Direct Current Stimulation (tDCS)
tDCS (Transcranial Direct Current Stimulation) is a non-invasive brain stimulation method that delivers a low electrical current to targeted areas of the brain using scalp electrodes. While it is not yet FDA-cleared in the U.S., it has been approved in the European Union for the treatment of fibromyalgia and migraine—and is widely studied for many other mental health and neurological conditions.
Widespread Use & Research
tDCS is one of the most heavily researched forms of brain stimulation, with over 6,000 studies indexed on MedLine. It’s currently being explored for:
• Depression, OCD, PTSD
• Cognitive enhancement & memory
• Stroke & traumatic brain injury recovery
• Parkinson’s, schizophrenia, epilepsy
• Eating disorders, tinnitus, anxiety
• And more
It has also shown potential to aid in weight loss, post-stroke aphasia, and autism—though more evidence is needed before clinical conclusions can be made.
Not Just for Clinics
tDCS is also popular among gamers, students, and high-performance professionals who use it to sharpen focus, improve memory, and increase reaction time. The U.S. military is currently studying its use for accelerating learning during training.
How It Works
tDCS sends a low-amplitude direct current (usually 1–2 mA) between two electrodes placed on the scalp. Depending on electrode placement (called a “montage”), different areas of the brain can be either stimulated or inhibited—impacting mood, attention, motor control, or cognition. These montages are based on the standardized 10-20 EEG system.
Device Options
There are a variety of tDCS devices available:
• Foc.us – Popular among consumers for brain performance.
• PriorMind – Features consistent current output and ease of use.
• ActivaDose / Chattanooga – Preferred in clinical settings due to FDA status for iontophoresis (not brain stimulation).
While many units are affordable and widely available online, users should exercise caution, ensure proper electrode placement, and consider consulting a professional.
📰 Featured in The New Yorker – “Electrified” by Elif Batuman: A deep dive into the world of personal brain stimulation and the future of neuro-enhancement.
tDCS Electrode Placement (Montages)
Unlike tACS, which adjusts frequency and waveform, tDCS uses a steady direct current—but the effects can vary significantly depending on where the electrodes are placed. This technique, known as a montage, determines which areas of the brain are either stimulated (anodal) or inhibited (cathodal).
Most montages are designed using the 10-20 EEG system, a standardized method for mapping locations on the scalp linked to different brain regions. For example, a common placement for depression targets left DLPFC (F3) to enhance mood regulation.
💡 By changing electrode locations, you can target different symptoms—such as improving focus, calming emotional reactivity, or relieving chronic pain.
You can explore dozens of montage maps and treatment guides at:
🔗 tDCSPlacements.com (Images and diagrams available)
If you want to buy a tDCS unit to use at home, you can. I neither encourage nor discourage this—in general, it is considered safe. There are many devices to choose from, and most have high-quality standards. The Chattanooga unit was smaller, more portable, and had two outputs instead of one, but it is no longer available and was not as user-friendly.
One well-engineered option is the PriorMind device. It works extremely well and includes circuitry that maintains a constant current even if skin impedance varies. It starts at 0.5 mA and can be increased to 2.0 mA, but it does not shut off automatically—so caution is required to turn it off manually.
The most obvious and best all-around choice for most people is www.foc.us. They offer complete systems with everything you need. Having purchased and used nearly every device on the market, I can say I’ve been consistently impressed with Foc.us and continue to order from them.
In the clinic, however, I use the ActivaDose device for legal reasons—because it has FDA clearance for iontophoresis, whereas Foc.us is technically classified as a recreational device.
Nerve Stimulation
Trigeminal Nerve Stimulation (eTNS)
Trigeminal Nerve Stimulation (eTNS) is a non-invasive therapy that delivers gentle electrical pulses to the forehead, targeting branches of the trigeminal nerve. This nerve connects to deep brain structures involved in mood, pain, and arousal regulation—making it a promising treatment for multiple conditions.
FDA-Cleared Devices
There are currently two FDA-cleared devices:
• Cefaly® – Cleared for the acute and preventive treatment of migraines and tension-type headaches. It’s available on Amazon, affordable, and in our experience, works excellently as a home device for headaches, anxiety, and insomnia.
• Monarch eTNS System (NeuroSigma) – Cleared for ADHD in children ages 12 to 17. While we haven’t yet used this device in the clinic, it shows strong potential.
Research-Based & Emerging Applications
In addition to its cleared indications, eTNS is being actively studied for a growing number of off-label conditions:
• Seizures / Epilepsy – Helps reduce seizure frequency and improve brain stability (Cook 2015; Soss 2015; Moseley 2014; Zare 2014; DeGiorgio 2003–2013).
• Depression – Modulates mood-related circuits through trigeminal-brainstem pathways (Shiozawa 2015; Cook 2013; Schrader 2011).
• PTSD – Calms hyperarousal and improves emotion regulation (Trevizol 2015).
• Fibromyalgia – May relieve widespread pain and improve quality of life (Shiozawa 2014).
• Generalized Anxiety Disorder (GAD) – Helps balance excitatory and inhibitory brain systems (Trevizol 2015).
In our clinical experience, eTNS is safe, well-tolerated, and effective for patients seeking non-pharmacological options.
How it works
eTNS delivers gentle electrical pulses to the skin on the forehead, stimulating branches of the trigeminal nerve. These signals travel to a deep brain region called the trigeminal nerve nucleus, which connects to important structures like the locus coeruleus and dorsal raphe nucleus—centers responsible for the release of norepinephrine and serotonin.
Nerve Stimulation
Transcutaneous Vagus Nerve Stimulation (tVNS)
tVNS is a breakthrough non-invasive therapy that gently stimulates the vagus nerve through the skin, particularly around the ear or neck. Unlike traditional Vagus Nerve Stimulation (VNS), which requires surgical implantation, tVNS delivers similar benefits without the risks, downtime, or cost of surgery.
From Surgery to Skin – A Safer Alternative
Surgical VNS was first FDA-approved in 1997 for epilepsy, then later for treatment-resistant depression in 2005, and weight loss in 2015. Transcutaneous versions emerged as a safer, simpler alternative that uses surface electrodes to activate vagal pathways.
Early research (Kraus 2007; Dietrich 2008) showed that stimulating the auricular branch of the vagus nerve (located on the outer ear) produces similar fMRI brain changes as implanted VNS—making tVNS a promising tool for medical and psychiatric care.
FDA-Approved Devices
• GammaCore® – Cleared for the treatment and prevention of migraines, cluster headaches, and hemicrania continua. It stimulates the vagus nerve through the neck (cervical tVNS).
• Bridge NSS-2® – Approved for opioid withdrawal symptoms. This is a percutaneous nerve field stimulator (PNFS) that also activates the trigeminal and great auricular nerves.
In Europe, other tVNS devices are approved for epilepsy (CerboMed-Nemos), pain, tinnitus (SaluStim), and headaches.
Off-Label & Investigational Uses
Although not yet FDA-approved for all applications, tVNS is under active research for a wide range of disorders:
• Depression & Mood Disorders (Fang 2015, Hein 2013, Trevizol 2016, Rong 2016, Kong 2018)
• Anxiety (Generalized, Panic, Social) (Fang 2015, Connolly 2013, Nejad 2013)
• Epilepsy / Seizure Disorders (Aihua 2014, DeGiorgio 2013, Bauer 2016, Liu 2018)
• Stroke Recovery (Redgrave 2018, Capone 2017, Ay 2016)
• Tinnitus (Chronic Ringing in the Ears) (Kreuzer 2014, Hyvarinen 2014, Yakunina 2018)
• Cardiac Conditions – including:
• Atrial fibrillation (Chen 2015, Yu 2013)
• Heart failure (Fan 2010, Wang 2014)
• Post-heart attack recovery (Wang 2015)
At our clinic, we’ve also observed positive effects on insomnia, emotional regulation, and stress resilience.
How tVNS Works
Transcutaneous Vagus Nerve Stimulation (tVNS) works by gently stimulating the auricular branch of the vagus nerve—a nerve fiber accessible through the skin of the outer ear. Though the stimulation occurs on the surface, its effects reach deep into the brain, influencing emotional regulation, physical health, and mental clarity.
Step-by-Step Mechanism of Action
1. Stimulation starts at the ear
Gentle pulses are applied to the outer ear, where a small patch of skin is innervated by the auricular branch of the vagus nerve.
2. Signal travels to the brainstem
These signals activate a key brainstem hub called the Nucleus Tractus Solitarius (NTS)—a relay station that integrates information from the heart, lungs, gut, and immune system.
3. From NTS to key neurotransmitter centers
The NTS sends projections to two critical areas:
• Locus Coeruleus – the brain’s main source of norepinephrine, responsible for energy, focus, and alertness.
• Dorsal Raphe Nucleus – the brain’s main source of serotonin, involved in mood regulation, calmness, and confidence.
4. Widespread chemical signaling
These two centers release neurotransmitters across the brain, especially to:
• The prefrontal cortex, responsible for decision-making and emotional control.
• Less to the amygdala and limbic system, which reduces the intensity of fear and panic responses.
5. The result?
More calm confidence (serotonin) and relaxed focus (norepinephrine)—and a nervous system that’s less reactive and more regulated.
Brain Connectivity & Emotional Wellbeing
Research shows that tVNS also enhances communication within the brain’s Default Mode Network (DMN)—a system active during self-reflection, memory, and rest. In depression, this network becomes overactive and inwardly focused.
tVNS helps by:
• Decreasing connectivity to areas linked to self-criticism (anterior insula, parahippocampus)
• Increasing connectivity to areas tied to emotional integration and calm self-awareness (precuneus, orbital prefrontal cortex) (Fang 2016; Connolly 2013; Berman 2011)
This shift may explain why tVNS can reduce rumination, emotional overwhelm, and negative thought patterns.
More Calm, Less Chaos: Autonomic Nervous System Effects
Beyond the brain, tVNS activates the parasympathetic nervous system (the “rest and digest” system), while reducing sympathetic tone (fight-or-flight response).
Key effects include:
• Improved heart rate variability (HRV) – a marker of nervous system flexibility and resilience (Clancy 2014)
• Lower levels of adrenaline and cortisol
• Enhanced relaxation, sleep quality, and digestive function
• Protective effects in cardiac health, blood pressure, and metabolic regulation
In short, tVNS uses a small pulse at the ear to tap into a powerful network of brain and body systems—helping restore balance, reduce stress, and support healing from within.
Does Vagus Nerve Stimulation Help with Medical Conditions Too?
Yes—vagus nerve stimulation isn’t just for mental health. In fact, much of the early research on Vagus Nerve Stimulation (VNS) focused on its impact on seizures and inflammation, with surprising results across a wide range of medical conditions.
In 1997, the FDA approved surgical VNS (by Cyberonics) for epilepsy, and later for treatment-resistant depressionand weight loss. Since then, ongoing research has uncovered even more therapeutic possibilities.
The Work of Dr. Kevin Tracey
Dr. Kevin Tracey, a surgeon and scientist in New York, played a pivotal role in uncovering how vagus nerve stimulation influences the immune system. In his landmark 2003 paper, “The Cholinergic Anti-Inflammatory Pathway,” Tracey described how stimulating the vagus nerve could reduce systemic inflammation by signaling the body to downregulate immune overactivity.
This discovery created an entirely new field of research known as neuroimmunomodulation—exploring how brain-based interventions can help treat autoimmune, inflammatory, and metabolic diseases.
In March 2015, Scientific American dedicated an entire special issue to vagus nerve stimulation and its remarkable potential in medicine—highlighting the ability to modulate inflammation, mood, and even organ function through a simple neural circuit.
Brightening Mood Naturally
Light Therapy
Light therapy is a non-invasive treatment that uses specific wavelengths of light to help regulate your brain’s natural rhythms—especially those related to mood, sleep, and energy. It’s been used successfully for decades to treat Seasonal Affective Disorder (SAD), also known as the “Winter Blues.”
What It Helps
Research shows that light therapy can also benefit individuals with:
• Major Depressive Disorder (MDD)
• Premenstrual Dysphoric Disorder (PMDD)
• Sleep-wake cycle disorders
• Low energy or motivation in darker months
Exposure to bright light early in the day can help reset the body’s internal clock (circadian rhythm), promote better sleep, and boost serotonin production, which is key for stabilizing mood.
From Bulky Boxes to Portable Solutions
In the past, light therapy required large, stationary light boxes with specific brightness and frequency settings. Today, portable, affordable, and effective options are widely available for home use—including wearable devices and compact lamps. Many high-quality light boxes can be found on Amazon or eBay, making it easy to start treatment at home.
How It Works
• Most light boxes emit 10,000 lux of full-spectrum light.
• Sessions typically last 20–30 minutes each morning.
• Users sit comfortably in front of the light while reading, working, or eating.
Light enters through the eyes (not the skin) and stimulates brain regions involved in regulating mood, energy, and sleep cycles—without UV exposure.
Schedule an Appointment
Take the Next Step
- Learn more about how brain stimulation can help you
- Discuss your unique symptoms with our experts
- Get a personalized assessment
- Receive a unique treatment plan
- Start your journey toward lasting relief
Don’t wait to feel better—take control of your mental health today!
