The science of Flow

Flow Neuroscience is medical device company. Our mission is to conduct research around mental health among world-class institutions, and build credible, scientific evidence within the healthcare environment. Today, Flow Neuroscience works with some of the world’s leading researchers in the field of brain stimulation to build at-home medical devices so that more patients than ever before can be treated in a safe and effective way from the comfort of their home.

The Flow headset

During the last 20 years, evidence has emerged about the efficacy of Transcranial Direct Current Stimulation (tDCS), a non-invasive brain stimulation technique, which works by stimulating the brain using a weak, barely noticeable, electric signal in order to change neural activity patterns beneath the stimulated areas.

Numerous scientific studies have shown that this technique has similar levels of efficacy on clinically depressed patients as talk therapy (e.g. Cognitive Behavioural Therapy) or antidepressant medications. What sets tDCS apart from medication is that it has almost no side-effects, besides slight irritation of the skin under the stimulation area and mild headaches that pass 30 minutes after the stimulation. tDCS is currently used on a small scale by researchers, specialised labs, and hospitals in countries, including the US, Germany and Italy. The results of a recent randomised controlled trial (RCT) on 245 patients show that 41% of the patients had a 50% reduction or more in their depression symptoms.1

A collection of eight RCT studies conducted up until 2016 can be found in this review.2

1. Brunoni, A. R., Moffa, A. H., Sampaio-Junior, B., Borrione, L., Moreno, M. L., Fernandes, R. A., Benseñor, I. M. (2017). Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression. New England Journal of Medicine (26), 2523–2533. https://doi.org/10.1056/NEJMoa1612999

2. Brunoni, A. R., Moffa, A. H., Fregni, F., Palm, U., Padberg, F., Blumberger, D. M., … Loo, C. K. (2016). Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. The British Journal of Psychiatry : The Journal of Mental Science, 208(6), 522–531. https://doi.org/10.1192/bjp.bp.115.164715

The “Flow – Depression” app

While users wear the headset, they interact with an AI-powered app therapy program. The app provides original video content, information and advice about lifestyle changes specifically aimed at reducing depression. It teaches the user about depression, and how to reduce it, using techniques for improved sleep,3 healthier eating4 effective exercise5 and stress-reducing meditation.6 Below you can find a few examples of the studies or scientific reports we have reviewed as part of the development of the Flow app.

Download Flow – Depression

3. The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis. Andrea Ballesio a, Maria Raisa Jessica V. Aquino b, Bernd Feige c, Anna F. Johann c, Simon D. Kyle d, Kai Spiegelhalder c, Caterina Lombardo a, Gerta Rücker e, Dieter Riemann c, Chiara Baglioni. Sleep Medicine Reviews 37 (2018) 114-129

4. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Anika Knüppel , Martin J. Shipley, Clare H. Llewellyn & Eric J. Brunner. SCIENTIFIC REPORTS | 7: 6287 | DOI:10.1038/s41598-017-05649-7

5. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. Felipe B. Schuch a, b, *, Davy Vancampfort c, d, Justin Richards e, Simon Rosenbaum f, Philip B. Ward f, Brendon Stubbs g, h. Journal of Psychiatric Research 77 (2016) 42e51

6. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis.Paul Blancka,∗, Sarah Perletha, Thomas Heidenreichb, Paula Krögera, Beate Ditzenc, Hinrich Bentsa, Johannes Mander. Behaviour Research and Therapy 102 (2018) 25–35

Safety

Several large studies (so called meta analyses) have shown the side effects of the brain stimulation technique used by Flow to be mild and short-term. 7,8,9

Side effects that are common with tDCS are:

  • A tingling/burning sensation underneath the electrodes during stimulation
  • Mild headaches after using the device

Stimulation should never been painful. Every user is different regarding skin sensitivity and you should always abort stimulation should you experience any pain.

Please contact a healthcare professional should your symptoms of depression or anxiety get worse.

7. Bikson et al., Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimulation, 9(2016), 641–661. http://dx.doi.org/10.1016/j.brs.2016.06.004

8. Aparício et al., A Systematic Review on the Acceptability and Tolerability of Transcranial Direct Current Stimulation Treatment in Neuropsychiatry Trials. Brain Stimulation, 9(5), 671–681. https://doi.org/10.1016/j.brs.2016.05.004

9. Nikolin et al., Safety of repeated sessions of transcranial direct current stimulation: A systematic review. Brain Stimulation 11 (2018) 278-288. https://doi.org/10.1016/j.brs.2017.10.020

The Flow headset

In the last 20 years, strong evidence has emerged on the efficacy of tDCS, a less invasive, brain stimulation technique, based on stimulation of the brain using a weak, barely noticeable, electric signal in order to change neural activity patterns beneath the stimulated areas.

Numerous scientific studies have shown that this technique has similar levels of efficacy on clinically depressed patients as talk therapy (e.g. CBT) or antidepressant medications., What sets tDCS apart is that, few side-effects were observed aside of mild irritation of the skin under the anode (the plus electrode) and mild headaches that pass 30mins after the stimulation. tDCS is currently used at a small scale by researchers, specialized labs, and hospitals in the US and a few countries, like Germany and Italy.The results in the latest randomised controlled trial (RCT) study on 245 patients shows that 41% of the patients had a 50% reduction or more in their depression symptoms.  (LINK)
A collection of the 8 RCT studies conducted until 2016 can be found in this review from the same year.(LINK)
References
1. Brunoni, A. R., Moffa, A. H., Sampaio-Junior, B., Borrione, L., Moreno, M. L., Fernandes, R. A., Benseñor, I. M. (2017). Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression.
New England Journal of Medicine (26), 2523–2533. https://doi.org/10.1056/NEJMoa16129992. Brunoni, A. R., Moffa, A. H., Fregni, F., Palm, U., Padberg, F., Blumberger, D. M., … Loo, C. K. (2016). Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. The British Journal of Psychiatry : The Journal of Mental Science, 208(6), 522–531. https://doi.org/10.1192/bjp.bp.115.164715

The "Flow - Depression" app

While users wear the headset they interact with an AI-powered app therapy program. The app provides original video content, information and advice about lifestyle changes specifically aimed at reducing depression. It teaches the user about depression, and how to reduce it, using techniques for improved sleep (Ref 3), healthier eating(Ref 4)effective exercise(Ref 5) and stress-reducing meditation (Ref 6). Below you can find a few examples of the studies or scientific reports we have reviewed and that is the groundwork of the Flow app.

References

3.The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis.
Andrea Ballesio a, Maria Raisa Jessica V. Aquino b, Bernd Feige c, Anna F. Johann c, Simon D. Kyle d, Kai Spiegelhalder c, Caterina Lombardo a, Gerta Rücker e,
Dieter Riemann c, Chiara Baglioni. Sleep Medicine Reviews 37 (2018) 114-129

4.Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the
Whitehall II study. Anika Knüppel , Martin J. Shipley, Clare H. Llewellyn & Eric J. Brunner. SCIENTIFIC REPORTS | 7: 6287 | DOI:10.1038/s41598-017-05649-7

5. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. Felipe B. Schuch a, b, *, Davy Vancampfort c, d, Justin Richards e, Simon Rosenbaum f, Philip B. Ward f, Brendon Stubbs g, h. Journal of Psychiatric Research 77 (2016) 42e51

6. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis.Paul Blancka,∗, Sarah Perletha, Thomas Heidenreichb, Paula Krögera, Beate Ditzenc, Hinrich Bentsa, Johannes Mander. Behaviour Research and Therapy 102 (2018) 25–35