PEMF Therapy for Mental Health: A Summary of Studies
Many studies have been conducted in the past decade on Pulsed ElectroMagnetic Field (PEMF) therapy in the areas of mental health, including Depression, GAD, Insomnia, PTSD and cPTSD.
This article summarises some of the studies conducted, but is not an exhaustive list. It will be updated as and when we discover more information in the field.
1. Study Focus: PEMF / Neuromodulation for Depression
Study Title: Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression
No. of Participants: 21
Protocol: Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression.
Methods: Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT.
Results / Findings: Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. Double-blind RCTs needed.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/32252538
2. Study Focus: PEMF effects on the heart (human ECG readings)
Study Title: An Investigation on the Effect of Extremely Low Frequency Pulsed Electromagnetic Fields on Human Electrocardiograms (ECGs)
Location: not stated
No. of Participants: 22
Protocol: The experiment was conducted under single-blind conditions. The root mean square (RMS) value of the recorded data was considered as comparison criteria. Measurements via ECG were taken before and after a short PEMF session.
Results / Findings: Results revealed that the RMS value of the ECG recordings from 18 participants (81.8% of the total participants) increased with a mean value of 3.72%. The increase in ECG voltage levels was then verified by a second experimental protocol with a control exposure. In addition to this, we used hyperbolic T-distributions (HTD) in the analysis of ECG signals to verify the change in the RR interval. It was found that there were small shifts in the frequency-domain signal before and after EMF exposure. This shift has an influence on all frequency components of the ECG signals, as all spectrums were shifted. It is shown from this investigation that a short time exposure to ELF-PEMF can affect the properties of ECG signals. Further study is needed to consolidate this finding and discover more on the biological effects of ELF-PEMF on human physiological processes.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/27886102
3. Study Focus: TDCS versus SSRI with Placebo Control for Depression
Study Title: Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression
No. of Participants: 245
Protocol / Methods: In a single-center, double-blind, noninferiority trial involving adults with unipolar depression, we randomly assigned patients to receive tDCS (Transcranial Direct Current Stimulation) plus oral placebo, sham tDCS plus escitalopram, a Selective Seratonin-Reuptake Inhibitor (SSRI), or sham tDCS plus oral placebo. The tDCS was administered in 30-minute, 2-mA prefrontal stimulation sessions for 15 consecutive weekdays, followed by 7 weekly treatments. Escitalopram was given at a dose of 10 mg per day for 3 weeks and 20 mg per day thereafter. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS-17) score (range, 0 to 52, with higher scores indicating more depression). Noninferiority of tDCS versus escitalopram was defined by a lower boundary of the confidence interval for the difference in the decreased score that was at least 50% of the difference in the scores with placebo versus escitalopram.
Results / Findings: A total of 245 patients underwent randomization, with 91 being assigned to escitalopram, 94 to tDCS, and 60 to placebo. In the intention-to-treat analysis, the mean (±SD) decrease in the score from baseline was 11.3±6.5 points in the escitalopram group, 9.0±7.1 points in the tDCS group, and 5.8±7.9 points in the placebo group.
The lower boundary of the confidence interval for the difference in the decrease for tDCS versus escitalopram (difference, -2.3 points; 95% confidence interval [CI], -4.3 to -0.4; P=0.69) was lower than the noninferiority margin of -2.75 (50% of placebo minus escitalopram), so noninferiority could not be claimed. Escitalopram and tDCS were both superior to placebo (difference vs. placebo, 5.5 points [95% CI, 3.1 to 7.8; P<0.001] and 3.2 points [95% CI, 0.7 to 5.5; P=0.01], respectively).
Patients receiving tDCS had higher rates of skin redness, tinnitus, and nervousness than did those in the other two groups, and new-onset mania developed in 2 patients in the tDCS group. It is important to find out which device exactly was used, manufactured by which company and to which quality standards, as well as the voltage and amperages used during treatment. No other studies have reported participants experiencing tinnitus or nervousness due to tDCS, TMS or PEMF for any mental health condition or physical condition which was studied.
Patients receiving the SSRI escitalopram had more frequent sleepiness and obstipation than did those in the other two groups.
Conclusions: In a single-center trial, tDCS for the treatment of depression did not show noninferiority to escitalopram over a 10-week period and was associated with more adverse events.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/28657871 and https://clinicaltrials.gov/ct2/show/NCT01894815
4. Study Focus: Depression
Study Title: Transcranial low voltage pulsed electromagnetic fields in patients with treatment-resistant depression
No. of Participants: 50
Protocol: In this study, a patient with treatment resistant depression, as defined by Harold Sackeim, is subjected to 5 weeks of treatment with active or sham PEMF treatment for 30 minutes on every working day. A second arm was given sham treatment for the same duration and frequency of sessions. The pharmacological treatment for depression is maintained unaltered throughout the study. Depression severity is measured at the beginning of the study and at each weekly visit. Side effects are closely observed. The ability to concentrate is measured by the AQT test (Alzheimers Quick Test). Personality is assessed by use of the SCID-II-instrument (DSM-IV axis II).
Results / Findings: Outcomes were measured on the HDR and AQT. Patients on active T-PEMF showed a clinically and statistically significant better outcome than patients treated with sham T-PEMF, with an onset of action within the first weeks of therapy. Effect size on the Hamilton 17-item Depression Rating Scale was .62 (95% confidence interval .21-1.02). Treatment-emergent side effects were few and mild.
Conclusion: The T-PEMF treatment was superior to sham treatment in patients with treatment-resistant depression. Few side effects were observed. Mechanism of the antidepressant action, in light of the known effects of PEMF stimulation to the brain, is discussed.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/20385376 and https://clinicaltrials.gov/ct2/show/NCT00287703
5. Study Focus: PEMF for Depression
Study Title: The Diagnostic Apathia Scale predicts a dose-remission relationship of T-PEMF in treatment-resistant depression
Location: Denmark (?)
No. of Participants: 65 total, 34 of which in placebo/sham group
Protocol: The apathy subsyndrome consists of the symptoms of fatigue, concentration and memory problems, lack of interests, difficulties in making decisions, and sleep problems. We evaluated 65 patients with therapy-resistant depression. In total, 34 of these patients received placebo T-PEMF in the afternoon and active T-PEMF in the morning, that is, one daily dose. The remaining 31 patients received active T-PEMF twice daily. Duration of treatment was 8 weeks in both groups. The Hamilton Depression Scale (HAM-D17) and the Bech-Rafaelsen Melancholia Scale (MES) were used to measure remission. We also focused on the Diagnostic Apathia Scale, which is based on a mixture of items from the MINI and the HAM-D17/MES.
Results / Findings: In patients without apathy, the remission rate after T-PEMF was 83.9% versus 58.8% in patients with apathy (p≤0.05). In patients without apathy receiving one active dose daily 94.4% remitted versus 50% for patients with apathy (p≤0.05). In patients without apathy who received two active doses 69.9% remitted versus 66.7% for patients with apathy (p≤0.05).
Link to Study: https://pubmed.ncbi.nlm.nih.gov/25273893
6. Study Focus: Pain, Anxiety, Depression and More
Study Title: Efficiency of pulsed electromagnetic fields on pain, disability, anxiety, depression, and quality of life in patients with cervical disc herniation: a randomized controlled study
No. of Participants: not stated
Protocol: Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0–10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment.
Results / Findings: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment.
Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/31385489
7. Study Focus: Depression
Study Title: Dose-remission of pulsating electromagnetic fields as augmentation in therapy-resistant depression: a randomized, double-blind controlled study
Location: Denmark (?)
No. of Participants: 34
Objective: To evaluate to what extent a twice daily dose of Transcranial Pulsating ElectroMagnetic Fields (T-PEMF) was superior to once daily in patients with treatment-resistant depression as to obtaining symptom remission after 8 weeks of augmentation therapy.
Methods: A self-treatment set-up of the T-PEMF device was used allowing self-administration by patients in own homes. All patients were treated for 30 min per T-PEMF session. The antidepressant medication the patients were receiving at baseline remained unchanged during the trial. The patients were randomised to either one T-PEMF dose (active dose in the morning and sham in the afternoon) or two T-PEMF doses (active dose both morning and afternoon) in a double-blind procedure. A score of 7 or less on the Hamilton Depression Scale (HAM-D17) was the criterion of remission.
Results: In total 34 patients received active T-PEMF once a day and 31 patients twice daily. After 5 weeks of therapy remission was obtained in 26.5% and 32.3% on one dose and two doses of T-PEMF, respectively. After 8 weeks the rate of remission was 73.5% and 67.7%, respectively. The side effects as measured by the Udvalget for Kliniske Undersøgelser scale showed a better toleration of the antidepresssive medication in both treatment groups, which was reflected by the WHO-5 well-being scale with increased scores in both groups of patients.
Conclusion: The high remission rate obtained by the T-PEMF augmentation was not a dose effect (one versus two daily T-PEMF sessions) but was explained by the extension of the treatment period from 5 to 8 weeks.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/25241755
8. Study Focus: Pain (related to MS)
Study Title: Effectiveness of monopolar dielectric transmission of pulsed electromagnetic fields for multiple sclerosis-related pain: a pilot study
No. of Participants: 24
Material and methods: This study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale.
Results: Statistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups.
Conclusions: Treatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/34238526
9. Study Focus: Multiple Chemical Sensitivity
Study Title: Transcranial pulsed electromagnetic fields for multiple chemical sensitivity: study protocol for a randomized, double-blind, placebo-controlled trial
No. of Participants: 39
Protocol: Device: Pulsed electromagnetic fields, Other Names:
- Re5 Independent System
- Re5 therapy
Versus sham device.
Results / Findings: Outcome measure on the Change from baseline in Life Impact Scale (Quick Environmental Exposure and Sensitivity Inventory) [ Time Frame: Week 1, 2, 3, 4, 5, 6, and 2½ and 4½ month follow-ups ], secondarily on the Sheehan Disability Scale and more such as noise sensitivity. Results of findings have not been posted, so it can be assumed that this study did not reveal promising or positive results.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/23947742
10. Study Focus: PTSD and Traumatic Brain Injury
Study Title: Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans
Unfortunately, there is too little evidence posted to draw conclusions from this small treatment group in the pilot study.
Link to Study: https://pubmed.ncbi.nlm.nih.gov/22772672
11. Study Focus: PTSD
Study Title: Image-guided, Robotically Delivered Transcranial Magnetic Stimulation Treatment for Combat-Related Post-Traumatic Stress Disorder
Location: Texas, USA
No. of Participants: 119
Protocol: Device: Active repetitive transcranial magnetic stimulation
The MagPro R30 is an advanced, high performance magnetic stimulator designed primarily for non-invasive clinical use. The non-invasive brain stimulation system will be used to deliver active repetitive electromagnetic pulses in this research study’s treatment of post-traumatic stress disorder.
Other Name: rTM
Device: robotic arm, This robotic system is based on a commercially available neurosurgical robot. The robot is mounted on a mobile (i.e. retractable wheels) cart which holds the robot controller and the TMS power supply and pulse-generation computer. The robotic system will be used for TMS coil positioning/targeting.
Findings: Outcomes measured by changes in PTSD Severity as Measured by the PTSD Checklist (PCL-5) [ Time Frame: Baseline to three weeks (the conclusion of rTMS treatment) ], also changes in Depression severity
Link to Study: https://clinicaltrials.gov/ct2/show/NCT02853032
12. Focus: PTSD
Study Title: A Pilot Study of Low Field Magnetic Stimulation in PTSD: Three Daily Treatments (LFMS in PTSD)
Location: Massachusetts, USA
No. of Participants: 24
Protocol: Device: Low Field Magnetic Stimulation. The LFMS Device is an electromagnetic coil situated on a cylinder with an inside diameter of 13.2 inches. It produces weak electromagnetic fields at a frequency of about 1000Hz; the magnetic fields are less than 30 Gauss and the electric fields are up to 1.43 V/m. A fully detailed description of the electromagnetic field distribution and waveform has been presented in the IDE submission to the FDA (and determined to be a non-significant risk device).
Methods: We used a randomized, double blind, sham controlled treatment protocol to study the effects of LFMS in a large group of stably medicated, depressed patients with either BPD (n = 41) or major depressive disorder (n = 22). Subjects received a single, 20-minute treatment. Change in mood was assessed immediately afterward using a visual analog scale (VAS), the 17-item Hamilton Depression Rating Scale (HDRS-17), and the Positive and Negative Affect Schedule scales.
Results: Substantial improvement (>10% of baseline) in mood was observed following LFMS treatment relative to sham treatment for both diagnostic subgroups for our primary outcomes, the VAS and the HDRS-17. These differences were not statistically significant in primary analyses stratifying by diagnosis but were significant in secondary analyses combining data across the two diagnostic groups (p = .01 VAS, p = .02 HDRS-17). Rapid improvement in mood was also observed using the Positive and Negative Affect Schedule scales as secondary measures (positive affect scale p = .02 BPD, p = .002 combined group). A finite element method calculation indicates a broad penetration of the LFMS electric field throughout the cerebral cortex.
Conclusions: Low field magnetic stimulation may produce rapid changes in mood using a previously unexplored range of electromagnetic fields.
Link to Study: https://clinicaltrials.gov/ct2/show/NCT02545192 and https://pubmed.ncbi.nlm.nih.gov/24331545
13. Study Focus: PTSD
Study Title: Multi-site Confirmatory Efficacy Treatment Trial of Combat-related PTSD
Location: Texas, USA
No. of Participants: 330
Protocol: 3 arms, active, sham or CBT. MRIs collected at 6 and 12 month marker. EEGs collected at 1, 6 and 12 month markers.
Findings: Will be published in 2023 or later.
Link to Study: https://clinicaltrials.gov/ct2/show/NCT03932773
A Note on Clinical and Cost Effectiveness of PEMFt
The UK National Institute for health and Care Excellence (NICE) issued guidelines for the treatment of PTSD in adults and children, in 2018. These treatment guidelines looked very thoroughly at pharmacological (medication / drug) and non-pharmacological treatments such as TMS, PEMF, yoga, CBT, acupuncture, EMDR and others.
It was found that the combination of somatic and non-somatic therapies were most successful (see Evidence Review D, page 366). That is to say, talking therapy and a non-verbal therapy work best together to address PTSD.
There have been other meta analyses conducted outside the UK, for example by one group in the USA, linked to here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224348
Given this information and the wider scope of clinical application, the need for PTSD treatment is growing. It is being discovered that elderly and older persons show signs of PTSD differently. The recent COVID-19 pandemic, economic uncertainties, Russian-led war in Ukraine, USA-led and USA-backed wars in other countries, as well as refugees from gang violence, famine and climate change are all increasing the need for PTSD treatment.
Especially because PEMF therapy does not require language skills (i.e. fluency in English), this is especially suitable for refugees, children, and non-verbal persons. It can be quickly and easily adopted into clinics and standard practice in many countries regardless of potential language barrier (i.e. Afghanistan, Iraq, native populations in Mexico not speaking Spanish).
Further evidence done in the UK shows that people are more willing to reach out to others in their ‘group’ for support, whether identified by religious, cultural or other means. It is easiest to have trained individuals operate PEMF devices than to train them in pharmacology to prescribe medications, or perform a 4-year degree for clinical behaviour psychology to conduct CBT.
PEMF – at least on the devices we use, running on the user-friendly software we’ve developed – is easy to use and implement by persons not medically trained. Therefore, this therapy can be quickly rolled out to help many patients the world over in their recovery from PTSD and Trauma.