Dr. Chapa’s OBGYN Clinical Pearls

Episode: Brain Zapping at Home Now Approved!
Date: January 2, 2026
Host: Dr. Chapa

Overview

In the first episode of 2026, Dr. Chapa dives into a groundbreaking FDA approval: the first at-home brain stimulation device for depression now available in the U.S. While struggling with a New Year's cold, Dr. Chapa provides an engaging, evidence-based walkthrough of what “brain zapping” entails, the science behind it, and the latest clinical data. The discussion is tailored for clinicians (especially in women’s health), highlighting practical aspects, efficacy, and how this technology fits into the evolving landscape of depression management.

Key Discussion Points & Insights

1. Why Brain Stimulation?

• Depression in Women:
  • Women suffer from mood disorders at roughly double the rate of men in the U.S. (CDC data).
  • OB/GYNs frequently encounter mood disorders, sometimes primary, sometimes secondary (e.g., chronic pelvic pain, infertility, PCOS). (01:55)
  • “Even the CDC says female depression and female mood disorders has a 2 to 1 female to male predominance.” — Dr. Chapa (02:16)

2. The New FDA-Approved Device

• Device & Company:
  • Manufacturer: Flow Neuroscience
  • Device: FL100
  • Type: Transcranial Direct Current Stimulation (tDCS)
  • How it works: Targets the right and left dorsolateral prefrontal cortex with mild electrical current. (03:25)
  • App-enabled, at-home treatment, debuting in the U.S. in 2026; previously available in Europe, UK, Switzerland, Hong Kong since 2019. (03:56)

3. Treatment Protocol & Clinical Details

• How it’s used:
  • 2 milliamp current, 30 minutes per session
  • Administered for 10–12 weeks (5 sessions/week initially, then 3/week)
  • Either as a standalone treatment or adjunct to medication/psychotherapy
  • “We’re not doing home ECT here. ... This is two milliampules for 30 minutes per session...” — Dr. Chapa (05:06)
• For Whom:
  • Unipolar major depressive disorder (NOT for bipolar/schizophrenia)
  • FDA approved for adults 18+

4. The Clinical Evidence—Three Key Years

a) 2023 — The Doubter: The Lancet Study

• RCT, triple-blind, Germany
• 150 patients (59% women)
• Compared tDCS + SSRI vs. sham + SSRI, over 6 weeks.
• Results: No superiority over sham.
  • “Active transdermal direct current stimulation was not ... superior to sham stimulation during a six week period...” — Dr. Chapa, quoting The Lancet (18:55)
• Limitations: Only 6 weeks duration; may need longer to see benefits.

b) 2024 — The Game-Changer: The Empower Study

• U.S. Phase 2, double-blind, placebo-controlled, fully remote, 10 weeks (foundation for FDA approval).
• Majority female participants (again 2:1 ratio).
• Results: Moderate improvement in depressive symptoms.
  • “So yeah, whether they were on antidepressant or psychotherapy or nothing, this seemed to work in a decrease ... on a depressive scale.” — Dr. Chapa (22:00)
• Used Hamilton Depression Scale to measure outcomes.
• Key Protocol: 30-minute direct stimulation sessions.

c) 2025 — The Referee: Systematic Review & Meta-analysis

• December 15, 2025, published in Scientific Reports
• 5 RCTs, total N=415
• Findings:
  • “Depression scores were moderately improved.”
  • Effective as both standalone and adjunct therapy.
  • “Even though some results remain mixed and even though we need larger, more standardized trials, this can be considered either as a standalone or as an adjuvant...” — Dr. Chapa, relaying study’s conclusion (24:12)

5. Cautions & Practical Considerations

• Dedication:
  • Results require adherence to a 10–12 week regimen; 6 weeks likely insufficient.
• Side Effects:
  • Mild, e.g., small skin irritation, mild headache.
• Cost:
  • Estimated $500–$800; insurance coverage TBA.
• Target Population:
  • Adults (FDA: 18+), unipolar depression.
• Not a Magic Bullet:
  • “It’s not a dramatic ... It’s a modest increase in mood or a decrease in score in the depression scale. And why not, if it’s going to make you feel better? Zap away, baby. Zap away.” — Dr. Chapa (25:55)
• Not for Bipolar or Schizophrenia:
  • “This is unipolar. This was not for bipolar. ... Just for major depressive disorder in adults.” — Dr. Chapa (14:40)

6. International Context

• Device not new globally:
  • Over 55,000 patients have used the device in Europe and Asia since 2019.
  • “Though it’s new to the U.S., it’s not new elsewhere.” — Dr. Chapa (04:08)

7. Broader Implications

• Non-pharmacologic option for those who struggle with medication or need augmentation.
• Continued need for larger, longer-term studies.
• Potential appeal for teens/young adults (though the device is only approved for 18+).

Notable Quotes & Memorable Moments

• “We’re kicking off the year, right? Happy New Year. ... Even though I know I sound terrible, it doesn’t matter. ... We’re going to get this thing done anyway.” (01:05)
• “We don’t usually think about at-home electrical shock therapy. But this is the thing.” (02:42)
• “Don’t go hook yourself up to your jumper cables ... down in the barrio of Texas. Don’t connect yourself to your 12 watt. ... This is two milliampules for 30 minutes per session...” (05:15)
• “If a patient asks you, ‘hey, can you write me the prescription ... so I can zap myself silly?’ You don’t go, ‘What?’ You go, ‘Oh, yeah, you want to zap yourself silly? Knock yourself out.’” (12:20)
• “This is big deal neuromodulation, hitting the prefrontal cortex to kind of rewire the brain. So this is the old ECT kicked down a notch for home use. Oh, my goodness.” (12:57)
• “If there’s any doubt you get kind of raw us on a raw me on the show, it’s me coughing up in a bronchos during this.” (21:04)
• “Zap away, baby. Zap away.” (25:55)

Timestamps for Major Segments

• 01:05 — New Year’s introduction & rationale for episode
• 02:16 — Depression stats & relevance to women’s health providers
• 03:25 — Introduction of Flow Neuroscience FL100 headset, tDCS basics
• 05:15 — Device technical details, humor about home ECT
• 12:20 — Prescription process & practicality for patients
• 12:57 — Neuromodulation context, safety, and continuum from ECT
• 18:55 — 2023 Lancet study minus findings on efficacy
• 22:00 — 2024 Empower study—basis for FDA approval
• 24:12 — 2025 meta-analysis—comprehensive assessment
• 25:55 — Take-home message, safety, moderation of effect

Final Summary

Dr. Chapa provides a spirited, clinically nuanced review of at-home transcranial direct current stimulation—now FDA-approved for major depressive disorder. This episode highlights shifting paradigms in mental health, the importance of duration and compliance for tDCS efficacy, and offers realistic, practical advice for integrating this technology into patient care. While not a panacea, modest yet meaningful mood improvements are possible for dedicated users. As Dr. Chapa says: “If it’s going to make you feel better? Zap away, baby. Zap away.”