Long term use

How long should you use Flow for?

How to use Flow

If using Flow is helpful for the first 10 weeks of your treatment, we recommend you to continue for at least another 6 to 12 months to help prevent you from relapsing, even if you have become symptom-free.

Step 1

Step 2

Step 3

Step 1 - Initial treatment period

The initial treatment period lasts for 10 weeks and is split into 2 parts:

The activation phase (3 weeks) - Flow is used for 30 minutes a day, 5 days a week to activate the neural network.
The strengthening phase (7 weeks) - Flow is used for 30 minutes a day, 2 days a week to support the progress made in the activation phase.

A large randomised controlled research study as well as Flow's real-world data (based on over 16,000 Flow users) indicate that 90% of the improvements people see with the Flow treatment usually occur within the first 10 weeks.

Read the study

Step 2 - Evaluate

After 10 weeks of treatment, use the following 3 scenarios to evaluate how to continue with Flow:

Your depression drops to minimal

Your depression improves, but you still have depression

Your depression does not improve

Step 3 - Continue for 6-12 months

According to current scientific evidence on depression relapse, everyone has a heightened risk of relapsing during the first 6 to 12 months following treatment. During that period, the brain is prone to falling back into depressive thinking and functioning.

Unfortunately, depression has a habit of coming back.

This is why it's so important to continue using Flow for at least 6 to 12 months after your initial 10 week treatment period.

Treatment length depends on your risk of relapse

Unfortunately, everyone is at risk of depression relapse. Some are low risk, whereas others are high risk.

After the initial 10 weeks, those at low risk should use Flow for at least 6 months, whereas those at high risk should use Flow for at least 12 months.

If you recognise any of the following factors, you may be high risk:

You have experienced childhood maltreatment (such as physical, emotional or sexual abuse, physical or emotional neglect, family conflict or violence).
You experience lingering symptoms from your last depressive episode (you were never fully recovered).
You have a history of prior depressive episodes.

Flow is safe to use long-term

There are no health risks associated with the technology used in the Flow headset (tDCS). On the contrary, research participants have used the same tDCS technology for 6 consecutive months without any changes in side effects, which is a good indication of long-term safety¹.

In addition, Flow’s long-term recommendations have been reviewed by a board of distinguished scientists, including Professor of Psychiatry at King’s College London, Allan Young.

However, research is performed on groups of people not individuals. So, we can never perfectly predict how the treatment will affect you as a unique individual with your unique health profile.

Read Wooham (2022)

Read Aparicio (2019)

FAQs

Who is at risk of depression relapse?

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.

How does depression relapse work?

According to current scientific evidence on depression relapse, everyone has a heightened risk 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.

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 the sooner you start treatment, the better. If you keep a Flow headset at home, you can begin immediately, as soon as the first symptoms appear.

Can relapse happen even if you stick to the Flow protocol?

Unfortunately, yes. Even though the Flow treatment can help lower the risk, relapse can still happen.

Depression is a severely complicated disorder with multiple causes. Biology, psychology, environment, hormonal fluctuations, stress, lifestyle factors, social and cultural factors all play a role in the development of depression. There is currently no depression treatment which can control all of those factors.

So, even if you do everything in your power to prevent depression, it may still come back. That is not a reflection of you or your treatment. It’s the nature of depression.

But remember, even if you suffer from recurrent depression, each episode is treatable. Read more about how to understand and prevent depression relapse here.

Are there any health risks to using Flow for 6-12 months?

There are no health risks associated with the technology used in the Flow headset (tDCS). On the contrary, research participants have used the same tDCS technology for 6 consecutive months without any changes in side effects. That is a good indication of long-term safety (see for example Woodham (2022), Aparicio (2019) and Valiengo (2013)).

In addition, Flow’s long-term recommendations have been reviewed by a board of distinguished scientists, including Professor of Psychiatry at King’s College London, Allan Young.

That’s why we can confidently recommend Flow for up to 12 months. Especially since the risk of depression relapse is heightened during that period.

However, we must always consider that research is performed on groups of people, not individuals. So, we can never perfectly predict how the treatment will affect you as a unique individual with your unique health profile.

Should you notice any considerable changes in side effects during your 6-12 months with Flow, contact our support at support@flowneuroscience.com. You should also speak to a clinician and consider discontinuing the treatment.

What happens if you keep stimulating beyond 12 months?

Our recommendations are ruled by science and created to ensure your safety. The research studies haven’t yet followed their participants beyond 12 months. Consequently, it’s unclear how tDCS affects the brain after several years of stimulation.

We don’t expect long-term tDCS to be harmful. There are no indications of that. We simply don’t fully know at this point.

Some Flow users have chosen to use the headset for over 3 years without noticing any changes in side effects. However, before this type of usage is studied in controlled research trials, we can’t predict the effect for large groups of people.

If you want to use Flow beyond 12 consecutive months, we recommend you to contact a clinic or another mental health professional with the ability to assess your condition and monitor your treatment.

Footnote

[1] Woodham, R.D., Selvaraj, S., Lajmi, N. et al. Nat Med (2024)