Interview: Flow’s Daniel Månsson on a new tech treatment for depression

Depression and mental health, and how to treat it, has become an increasingly big topic. Globally, more than 300 million people suffer from depression, and close to 800,000 people die due to suicide every year. Daniel Månsson, co-founder and CEO of Flow spoke to Digital Health Age about the concept he has worked on to treat patients with depression. It features a brain stimulation headset and an AI app. Flow will be available from early 2019, and you can find out more about it on:

How did the idea come about?

Whilst working in a research lab at Stockholm’s KTH Royal Institute of Technology I met neuroscientist Erik Rehn and, together, we began thinking about a huge, but simple, goal of helping as many people as possible to effectively treat depression. We started exploring the latest research around transcranial direct current stimulation (tDCS), a form of neurostimulation that delivers a gentle electrical signal to the head, and how this approach could be combined with lifestyle changes, including improved sleep, nutrition, meditation and exercise. After attending various brain stimulation conferences in Germany and the US Erik and I soon discovered that this field of neuroscience was both advanced and scientifically rigorous.

With our small team Erik and I decided to make this holistic approach available so more people could benefit from treating depression. And that led to the Flow you see today: a headset and app-based therapy program which offers a medication-free, affordable treatment for major depression that is accessible to everyone anytime, anywhere.

Does the treatment have any side effects?

Flow consists of a headset delivering gentle electrical pulses to the head and an app that helps the user with lifestyle changes, including improved sleep, nutrition, meditation and exercise.

In a large safety review conducted in 2016, and authored by 29 of the leading researchers in the field of brain stimulation, it was concluded that: “To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.”

The Flow device is well within these boundaries.

Although the technology has been deemed safe by the scientific community this does not mean that it is without side effects. tDCS has been associated with, for example, temporary redness in the skin underneath the electrodes and mild headaches. These symptoms soon clear after use of the device.

A lot of emphasis seems to be put on brain stimulation, what does this device do that other brain stimulation activities don’t – such as elements of talk therapy for example?

As previously mentioned, Flow consists of a headset and an app. The user engages with the app during the stimulation which, through a virtual therapist, teaches the user about depression and how to change your lifestyle, including improved sleep, nutrition, meditation and exercise.

Give us an example of the physical aspects of depression that this device can address?

Depression is a complex disorder that can produce a range of symptoms, including poor sleep, weight gain or loss, cognitive problems, suicidal thoughts and sexual issues. These symptoms could all be positively affected by the Flow treatment program.

How does this device address both the biological component of depression as well as the behavioural?

The headset uses transcranial direct current stimulation (tDCS), a form of neurostimulation that delivers a gentle electrical signal, which activates neurons in the left frontal cortex of the brain. People diagnosed with depression often have a lower activity in this area and the stimulation works to rebalance this activity. During this process the user interacts with a virtual therapist, via the app, to specifically treat the symptoms of depression. The app teaches the user about depression, and how to reduce it using techniques for improved sleep, healthier eating, effective exercise and stress-reducing meditation.

Can you guarantee this would work for everyone? Different people respond to different things/triggers so how can you legislate for that?

Like most treatments, Flow does not work for everybody. As an indication of effect, the brain stimulation technique used by Flow has been shown to reduce depression by at least 50% in 41% of the people using it for 18 sessions during a six-week period.

According to the same study, some users of tDCS will have a full recovery (about 23%) and some people will not get any effect at all. Most of the users will be somewhere in between. The Flow team and the scientific community are working hard to identify who will benefit most from the effect of the stimulation.

The Flow app will teach users about depression, and what they can do to reduce it and prevent it from coming back. The techniques taught in the app are based on rigorous scientific research and are in themselves powerful in reducing depression.

People can also be depressed for a variety of different reasons, is the Flow treatment a ‘one size fits all’ approach, or is it more flexible?

Flow is a treatment for major depression which, according to the World Health Organisation, affects more than 300 million people of all ages. It is the leading cause of disability worldwide. More women will be affected than men, and 1 in 5 of us will be affected by depression during our lives. Flow can be used in all instances where you are diagnosed with major depression.

When can we expect Flow to launch? And what kind of markets are you targeting with the product?

Flow is currently in the process of becoming a medical device via a strict regulatory audit process with the British Standard Institute (BSI), a notified body, to ensure its effectiveness and safety according to the strict requirements of the European Commission. We expect Flow to be certified by the end of 2018. The product will be available to a select group of people during January of 2019 and then rolled out on a larger scale in the UK and Sweden.

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