How to Use the Flow Treatment Long-term

Have you ever been prescribed antidepressant medication? If so, you were probably recommended to stay on them for at least a year, even if the medication started working within two months. Why?

Because depression has a habit of coming back.

The first 6-12 months following treatment is a sensitive period where you are at higher risk of relapse. During that period, the brain is more prone to falling back into depressive thinking and functioning.

You can imagine the process of recovering from depression as moving into a new home. As you recover, you put a lot of effort into sorting out the old patterns and obstacles that you want to leave behind, and packing up the treasured belongings you want to carry with you into the future.

Your old place, at Depression Lane, was a small and dim apartment without windows. For months or even years, you had no other choice but to turn left at the big intersection and drive back there every day after work.

Your new place is different. It’s bigger and has a nice view of the world outside. You worked really hard for it and it’s finally yours.

To get home after work, you need to turn right at the big intersection. Sometimes you forget and turn left. You don’t want to. You love your new place. It just happens. The left turn is so familiar.

Not until you’ve made enough right turns, the new route is automated. And you’re no longer at risk of driving back to Depression Lane out of old habit.

That process takes time.

That’s why your psychiatrist might encourage you to keep taking antidepressants for a full year, even if you’re symptom-free. And it’s why at the end of psychotherapy you spend considerable time on relapse prevention. It’s to put a roadblock on that left route until your brain automatically turns “right”.

As so often with depression, there is no 100% guarantee. Even with relapse prevention, depression might still happen. But prevention significantly lowers the risk.

Medication and psychotherapy, however, are not the only treatments which can prevent new episodes of depression.

There is scientific evidence to suggest that tDCS protects against depression relapse as well. And it can help you maintain the improvements you’ve made during treatment.

In 2022, Woodham and colleagues investigated the long-term effects of home-based tDCS treatment on depression. At a 6-month follow-up, 91.3 % of the participants had significantly improved and 73.9 % were depression-free. The treatment was safe and tolerable for all participants.

In 2019, Aparicio and colleagues found that tDCS treatment was safe to use long-term and effective at preventing depression relapse during a 6-month period. They noticed that two weekly tDCS sessions seemed more effective at preventing relapse than only one.

In the light of new scientific evidence, Flow Neuroscience’s team of clinical experts have created recommendations for long-term use of the Flow tDCS treatment.

These recommendations have been reviewed by a scientific board, including Professor of Psychiatry at King’s College London, Allan Young, and leading researcher in neuromodulation at the University of São Paulo, André Russowsky Brunoni.

How to use Flow to treat depression and lower the risk of relapse in 4 steps

Let’s begin with a short summary – a 4-step guide to the recommendations. And a more detailed explanation will follow after.

Step 1: Complete 5 stimulation sessions a week for 3 weeks.

Step 2: Complete 2 sessions a week for another 7 weeks.

Step 3: Evaluate – Is the Flow treatment helpful for me?

(You’ll find out how to answer this question in the section called Exactly how do you use the Flow treatment beyond 10 weeks?)

Step 4: If Flow is helpful, continue with 2 weekly sessions for another 6-12 months. This may prevent depression relapse and maintain your improvements.

How does depression relapse work?

According to current research on depression relapse, everyone has a heightened risk of relapse during the first 6-12 months following treatment. However, depression relapse can also happen during the course of a lifetime.

For around 50% of people who undergo depression treatment, depression appears as a one-time disorder which can be cured. For the other half, depression manifests as a recurrent disorder with periods of temporary recovery (remission) and relapse – similar to asthma or lupus.

These facts may not be particularly uplifting. But knowledge is power. Knowing how depression works places you in a much better position to manage it.

After a period of being symptom-free, you may start to notice depressive symptoms re-emerging. You may experience a low mood and a loss of interest in the things you usually enjoy. Perhaps negative thoughts and feelings refuse to leave you alone. If the symptoms persist for more than 14 days, they could indicate a depression relapse.

Please remember that even if your depression is of the recurrent kind, each episode is treatable. And since depression is usually more easily treated at an early stage – the sooner you start your treatment, the better.

Keeping a Flow headset at home allows you to begin immediately, as soon as the first symptoms appear. If a relapse occurs, reset your stimulation schedule in the Flow app and start your depression treatment from the beginning with 5 weekly sessions for the first 3 weeks. After the initial 10 weeks of treatment, continue for another 6-12 months.

Who is at risk of recurrent depression?

Researchers are still uncovering the causes behind depression relapse. Sometimes, difficult life experiences or seasonal changes trigger a relapse. Other times, depression seems to recur out of nowhere.

Currently, it’s unclear why some people experience depression as a recurrent disorder and why others only have one episode during their lifetime.

So, the frustrating truth is: everyone is at risk of depression relapse. And everyone would therefore benefit from relapse prevention.

Now, let’s go into more detail.

There are a few well-known risk factors which put people at higher risk of relapse. Note, their presence in your life is not a guarantee of relapse, they just represent an increased risk.

People with a heightened risk of relapse are recommended to stick to their Flow treatment for a longer period of time – 12 months after the initial 10 weeks of treatment (provided, of course, that the first 10 weeks have been helpful).

People with a low risk of relapse are recommended a minimum of 6 months treatment after the initial 10 weeks. Even though they’re not at high risk, everyone is vulnerable to relapse during the first 6 months following depression treatment.

So, how do you know if you are at high risk of relapse or low risk?

We can never know for sure, but if you recognise any of these risk factors, you are recommended to continue your Flow treatment for 12 months.