Flow and the NHS
Flow is now being used across the depression treatment pathway by 6 NHS services.
It is being offered as a monotherapy or combination therapy in Primary Care and various secondary care services (Community Mental Health, Crisis, Perinatal Mental Health).
Why are NHS services using Flow to treat depression?
1. It increases patient choice.
2. It can easily be combined with other treatment types.
3. It provides clinicians with another treatment option when others have failed.
4. It provides clinicians with a treatment option which can easily be used by the patient at home.
5. It delivers fast results.
6. There are no serious side effects associated with use of the device.
What are the results so far?
Case study 1: Flow in NHS Primary Care
In 2023 several General Practice Alliance GP surgeries in Northamptonshire began offering Flow as a monotherapy alternative to an antidepressant or therapy, or as an adjunctive treatment for those already on a stable dose of an antidepressant.
Northamptonshire Health Foundations Trust independently measured the results of this program by collecting PHQ9, WSAS and EQ5D before and after use of Flow. In addition, NHFT conducted a number of patient interviews to obtain qualitative patient feedback.
The results were published in two studies in the Journal of Depression1 and the team at NHFT concluded that "tDCS has evidence as an effective depression treatment, the widespread availability of tDCS in primary care general practice should be considered".
Key published results from the studies include PHQ-9 reliable improvement and remission rates of 58.1% and 32.3%.
Clinician feedback was also very positive. Azar Zhafar, GPA Director of Research and GP said "These findings have been incredibly promising and align with the valuable insights gained from utilizing Flow in primary care. Flow has gained significant popularity among our patients, and a considerable number of them willingly opt for Flow when presented with the choice for the treatment of depression with or without pharmacotherapy . This positive reception speaks volumes about the effectiveness and patient satisfaction associated with Flow."
NHS Practitioner Health
Flow is also now available via NHS practitioner Health for NHS clinicians with depression. Medical Director Dr Zaid Al-Najjar said, “Although we offer a wide range of treatments for mental health and addiction disorders, we are always on the lookout for new and innovative ways to support our patients. We are therefore excited to work with Flow Neuroscience to offer eligible patients an evidence based alternative treatment for depression where indicated.”
Case study 2: Flow in Community Mental Health
In 2023 NHFT began offering Flow to patients through its community mental health service2. Flow was offered as an adjunctive treatment alongside antidepressants, therapy or TMS.
Northamptonshire Health Foundations Trust independently measured the results of this program by collecting PHQ9, WSAS and EQ5D before and after use of Flow. In addition, NHFT conducted a number of patient interviews to obtain qualitative patient feedback.
The first results have been published in the Journal of Depression3 and the team at NHFT concluded that "Flow has been successfully integrated into a CMHT depression treatment. It is important to offer CMHT patients an evidence-backed alternative to existing depression treatments (anti-depressant medication and psychotherapies). The results support the use of Flow as a treatment option for CMHT patients with symptoms of depression."
Clinician feedback from the CMHT has been very positive
The Flow application is easy to use as is the headset, the treatment can be conducted from home and patients find this a very useful treatment……The use of neuromodulation techniques such as tDCS and TMS provide an alternative and effective treatment for that group of patients who are very difficult to manage with medication
Alex O’Neill-Kerr
Consultant Psychiatrist
For the patients that are responding to the Flow treatment, I have seen a notable reduction in contact required. There has been a reduction in requirement for face to face meetings, phone calls, medication reviews and psychiatric reviews....Patients have also greatly appreciated having a non-pharmaceutical treatment option, and being able to offer a non-pharmaceutical treatment option is also important to me
Simon Stringer
Community Mental Health Practitioner
Being able to offer Flow has been very well received from our patient group….Many of our patients are interested in an intervention which is not a medication or CBT. The choice is very valuable to them…..From a service perspective the headset has been easy to offer….As a team, Flow has been well regarded & received. The vibe within the team is that we are confident and proud to be exploring this option of treatment in addition to our usual care.
Will McIlhiney
Non-Medical Prescriber for Rural Parks CMHT
Case study 3: Flow in Perinatal Mental Health
In 2023 Northamptonshire Health Foundations Trust (or NHFT)’s perinatal mental health service began offering Flow as a depression treatment to women with postpartum depression and maternal loss. The goal was to increase patient choice.
The NHFT have published a paper with the results, saying "Participants reported positive experiences with Flow, highlighting its user-friendly interface, accessibility, and the availability of visual instructions...Participants appreciated a non-medication treatment alternative and reported improvements in depressive symptoms, mood, sleep quality, and overall well-being.
"The findings underscore the potential of Flow as a non-pharmacological intervention for depression."
Dr Carol Abraham, Specialty Doctor from NHFT Specialist Perinatal Mental Health Service
“We are pleased to be able to offer tDCS as part of a range of therapies as reviewed by NICE for the treatment of depression, especially as sometimes mothers prefer not to take medication if they are breastfeeding, or they have not had a good response in the past.”
Case study 4: Flow in Crisis Service
In 2024 Leicestershire Partnership Trust began offering Flow as a monotherapy alternative to an antidepressant or therapy, or as an adjunctive treatment for those already on a stable dose of an antidepressant.
Flow is offered to patients who are at risk of admission to hospital and need intensive treatment, and the goal is to help more people recover in their own homes, avoiding the need to go into hospital
Consultant Psychiatrist Mark McConnochie about the program so far:
"Since offering Flow we have found that patients are improving quickly and have fewer difficulties with side effects; indeed not a single patient has stopped treatment due to any negative effects at the current time, which is very different to many of the medication based treatments….We are seeing rapid improvements in patients who have been struggling with severe depressive symptoms for many years, and it is allowing us to treat more patients at home in a far better environment to promote recovery in their mental health journey."
References
1 "A Qualitative Study Exploring the Experience and Value of “Flow” Transcranial Direct Current Stimulation (tDCS) Device and Behaviour Therapy Training Software Application at Home for Symptoms of Depression" - link
"“Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Primary Healthcare General Practice—Depression, Functioning, and Health-Related Quality of Life Outcomes" - link
2 "Wearable headset helps treat symptoms of depression" - link
3 "A Qualitative Study Exploring the Experience and Value of Flow Transcranial Direct Current Stimulation (tDCS) and Behaviour Therapy Training Software Used at Home for Community Mental Health Team (CMHT) Patients with Symptoms of Depression" - link