Monday, February 06, 2006

Resistant Depression Looks to the Vagus Nerve Stimulator


Many people who experience depression have found tremendous relief of symptoms from talk therapy and antidepressant medications. But, there are many people whose depression does not improve with these treatments. These individuals have what is known in the clinical field as "treatment resistant depression". Up until now, those individuals with chronic depression were offered intensive treatments like Electro-Convulsive Therapy as a last resort.

Technology continues to be one the great cornerstones in treating psychological and psychiatric disorders. On July 15, 2005, the FDA approved Vagus Nerve Stimulation as a treatment for chronic depression.

The Vagus Nerve Stimulator (VNS) is not related to brain surgery, although it is a treatment that affects the function of the brain. VNS uses specific stimulation of the vagus nerve to send stimulation to specific parts of the brain that are involved in mood. It is not like Electro-Convulsive Therapy (ECT), a treatment that involves stimulation of the entire brain, results in short term memory loss and sometimes pain. Patients who have used VNS do not feel the stimulation from the stimulator since the vagus nerve does not have the type of nerves that carry pain signals. Nor does VNS interfere with memory loss. Patients having Vagus Nerve Stimulation can continue taking their other medications without worrying about side effects or interactions as well.

The Vagus Nerve Stimulator is a small device implanted under the skin near the collarbone. A wire under the skin connects the device to the vagus nerve in the neck. A physician programs the device to produce weak electrical signals that travel along the vagus nerve to the brain at regular intervals. These intervals ease the symptoms of depression. Five months after it was approved for sale, The VNS treatment for chronic, unresponsive or "resistant depression" is winning favor in the medical and psychological community.

Houston-based Cyberonics says a growing number of psychiatrists and surgeons are being trained to use its Vagus Nerve Stimulator, and an increasing number of insurance companies are agreeing to reimburse patients for their costs. In order to be a candidate for this new treatment, you must be a severely depressed adult who had not responded to at least four different treatment regimens.

As of December 2005, 62 insurance providers had agreed to pay for costs associated with VNS therapy. And many other insurance companies have agreed to reimburse patients who use the device on a case-by-case basis.

For those who have endured depression for many years without relief from traditional interventions, this new technology can offer life changing results. And it furthers our understanding that depression is a real, biological issue!


References

Anderson, B. et al. (2005). Vagus nerve stimulation affects pain perception in depressed adults. Pain Research & Management. 10(1), 9-14.

George, M.S. et al. (2005). A One-Year Comparison of Vagus Nerve Stimulation with Treatment as Usual for Treatment-Resistant Depression. Biological Psychiatry. 58(5), 364-373.

Vagus Nerve Stimulation Therapy @ http://www.vnstherapy.com/

36 comments:

Godwhacker said...

Health, mental health in particular, is something you can be pragmatic about.

Years ago, I had depression because I was in a bad relationship. I took drugs that mitigated the depression, but that was only a Band-Aid. The real problem was the bad relationship, not so much my body chemistry.

I think it's very important to look first for the underlying cause of depression first. A person in an abusive relationship has good reason to be depressed. The solution is to get out of the relationship.

This is why the role of a qualified therapist is so important. Drugs and devises like this should be used only a last resort and after a thorough evaluation has been made.

I think we are becoming too quick to use fast fixes.

Chris S. said...

Dr. Deb--This was very interesting but it reminded me of something. I worked in a cardiac lab for a number of years and one of the doc's there used vagus nerve stimulation (through massage) to convert a patient that was tachycardic. When using this method for depression, is there any concern about altering the patients cardiac impulses ? As a side note, my grandfather was subjected to electroshock therapy about 65-70 years ago to treat his depression...how sad that he had to endure thatas his only option. My mother told me he was never "right" after that. It didnt "cure" his depression and actually seemed to make him worse.
Chris

Traci said...

Oh Deb, this is wonderful information. I do take medication and for the most part it keeps me out of the black hole...but sometimes I wonder what will happen if I ever can't take the meds anymore. Depression runs in my family and is complicated by several other issues. It is very cool to hear about this treatment for those who do not respond to current available treatments. Electroshock stories have always scared me. Peace.

Blogzie said...

Science marches on!

Where would we be without it?

x0x0x

I n g e r said...

Funny how I read about the woman in France who had a face transplant, and I think, "Wow, science is fantastic," but read about this and my knee-jerk reaction is, "Hmm, vaguely sci-fi." Not sure if it's the relationship to ECT, which sounds like torture to our generation (though I've read also had distinct, though often accidental, benefits), or an ingrained bias against aggressive medical treatment of depression.

Another thought-provoking piece!

for_the_lonely said...

This article is beneficial for many people suffering from depression, including myself. I love to come here and learn new things about clinical studies...it's amazing how your body works!

I have a question...do you work with dreams as well? I only ask because I have this weird reoccurring dream where Jenn and I are together ( dating) , but she is at one location and I am at another. I try to call her, but can't get a hold of her at different places. After several calls, I try to call her at home, and forget the number, not sure if I am calling the right home number for us...when the phone rigns, it rings nonstop and she never answers..what the heck could all of this mean??? I am thinking that since I rely on her so much, it is the fear of being alone...not sure, though! LOL

Thanks Deb..you're the best!

Love,
Sarah

The Mass Defective said...

My psychiatrist mentioned VNS several months back as a possible course of treatment since my depression has been resistant to most anti-depressants and only slightly improved with the use of ECT (I've undergone ECT 3 times now).

I don't know what is scarier....living with this debilitating depression and being chronically suicidal, having something surgically implanted in my brain & hope it works where everything else has failed, or having the implant work and finally knowing what it's like to be depression free.

Guess it's something I need to give considerable thought to. Thanks for the information. I'd completely forgot about this option until I read your post.

dawn said...

oh geeze, that's amazing! wonder if they have this up here in canada? i'm going to do some more reading on this. it's very interesting. thanks :)

Dr. Deborah Serani said...

Dear Godwhacker,
It is true that situations can cause depression...it is extremely important to evaluate why symptoms are occuring. But for many who have biological depression, relief can be hard to find. Technology is helpful and continues to be a beacon of hope.

Dear Chris,
I do not know alot about VNS but I do believe there are contraindications for potential patients. I have had a few of my patients get ECT. Nowadays the treatment is less horrific and more clinically controlled. The ones who received it reported moderate to great improvement.

Dear Traci,
ECT carries a scary legacy, but like I said before, nowadays it is more refined. There is depression in my family too and anything that can help is something I want to know more about.

Dear Blogzie,
Yup, how true.

Dear Inger,
There are many people who have used ECT to great advantage, but we hear about the cases that did not go well. It does feel barbaric and has had a long history of scariness attached to it. I think technology is helping to make neuro-electrical treatment more refined and more site specific. It must have been just terrible to be severly depressed decades and even centuries ago.

Dear Sarah,
I do work with dreams. I will do apost about recurring dreams. What a good idea. It sounds ot me that you have the threads of the conflict...that needing and getting through so you are not alone is the theme.

Dear Mass Defective,
I am so pleased to know that you are researching your options. As you know, many people are unaware of how current treatment with ECT is used and how it can help. In your case, you may need something more site specific. I wish you good luck in this --- and hope that as you feel better you can enlighten us about your journey.

~Deb

Dr. Deborah Serani said...

Hey Dawn,
You sneaked in as I published my comments. I hope that you can get info on it up by you!

~Deb

tombotts.com said...

A good ass whipping works wonders. That or a frayed electrical cord in a tub of water. So you don't read my BLOG anymore. You don't love me. I'm depressed.

jumpinginpuddles said...

funny i thought up until now we were the only ones where anti depressants dont work. Figuring see we were the only ones then there was no point ever raising it. Thanks deb for the post you just did, being from another country means it wont be used here i guess for a while and even if it did we wouldnt probably take that option. LOL our short term memory loss is umm what did i say again LOL. So anymore help in that already loss loss would create a greater loss.
But it was interesting to read what you had to say and that we arent alone in the journey.

A Flowered Purse said...

That is great news for people like me who are afraid of pills and medicine! I once had a psychiatrist who told me when i was having a panic attack to thump the middle of my chest with 2 fingers, wonder if its along the same lines or something. Thanks so much for that deb!
Happy tuesday!
Dianna

Raine said...

I think I will wait a few years and see how it goes myself. I had ETC and the term "short term memory loss" was a joke. I lost ALOT of memory. I forgot a man I had been dating and never have remembered him. I only know about him cause he was sending me e-mails ( he had been shipped out in the national guard for 9-11) so its been a few years and I still cant remember him. Tho I must say there was some improvement with the ETC. For example i can bathe now and feed myself, it wasnt a cure. so I will wait and see before I play guineau pig again (oh to be fair I did have bi-lateral, I understand uni-lateral is less harsh)

Dr. Deborah Serani said...

Dear Tombotts,
Your wit aside, depression is a terrible disease, one that is no laughing matter. And with your blog, I was just there.

Dear JIP,
THe VNS is still in its early stages...I bet it's by you already.

Dianna,
The vagus nerve is not in the chest, but in the brain.

Dear Raine,
ECT stimulates the whole brain, if it is bilateral. As a result, memory loss is a risk. With VNS, no memory loss occurs. You've been through alot. I can understand wanting to wait for more research and reports on new treatments.

~Deb

Cathy said...

Dr.Deb;
I am still on the sociopath topic...I had someone lie and quite agressively to my face today. Something that they should have known I knew was a lie. I am wondering how common it is for such personalitites to be extremely violent?

Laura:) said...

very interesting. Sometimes I feel like depression is a part of life and can't image life being any different.

I have never been so depressed that it has consumed me or stopped me from leaving the house though. Some times I wonder if some people are depressed or just feeling low.

jumpinginpuddles said...

i dont think its in aus yet well if it is its not registering as being so but if you can find diff id be interested to know where its being practiced and by who

Grumpy Old Man said...

If they create a similar device that stimulates the pleasure centers, we'll all happily starve to death.

There'd be money in it, so watch for it.

cheesemeister said...

This sounds like a wonderful breakthrough. Unfortunately it came along too late for my second cousin. She committed suicide last summer after years of unrelenting depression that didn't respond to any kind of medication. I hope that maybe this will save some families the kind of heartache that her family has endured.
Peace,
Cie

Dr. Deborah Serani said...

Dear Cathy,
Predicting violence is something that is not a precise science. All I can tell you is to trust your instincts, If you feel this person has the potential to be aggressive, keep your distance.

Dear Laura,
Luckily, your depression is not severe or profound. There are many people who barely function. Feelings have ranges, that's for sure, and depression can be experienced from mild to profound.

Dear JIP,
I'll keep my ears and eyes vigilant for such info.

Dear GOM,
You are so right!!!

Dear Cheesemeister,
What a sad tragic story. Technology and research will hopefully help reach more individuals who suffer with depression.

~ Deb

Putti Angel said...

Wow, the advancement of technology never ceases to amaze me!! For people for whom the standard treatments have not worked, this sounds like an amazing option!! :D

Joel said...

One caution that I do not hear about the new technology is what might be called the Charly Syndrome. (After the character in Flowers for Algernon.) You introduce a new neuro-device. And the first results are excellent. The patient feels better. The psychiatrist and the neurosurgeon feel elated because they have found a way to master the body.

Then, gradually, like many meds, the procedure stops working. There are desparate attempts to tweak the hardware. They work for a short time, but the patient feels her/himself sinking. In the end, the patient is back where s/he was, but this time with a piece of hardware embedded in her/his neck that cost her/him thousands of dollars that the insurance company would not cover.

Is it worth it? I don't know. We have yet to see what the brain does with this. Does it get lazier? Will a sudden loss of power or surge hurt the patient?

Depression has not been a problem for me since I started taking lamictal, but I know others who haven't been so fortunate. Speaking for myself, if I were in that place, I wouldn't have the implant on the grounds that we know too little, far too little, about its effects on brain and body.

alan said...

I can only imagine the wonderful things that could be learned if only we could get some money spent on research...sadly, that's not going to happen for a while!

It used to be that doing something good for someone else was reward enough; now it has to pay as well. A sad statement on our "brave" new world!

alan

Dr. Deborah Serani said...

Dear Putti Angel,
Let's hope technology advances cures and treatments for all kinds of medical issues!

Dear Joel,
I am not familiar with Charly Sydnrome. Please point me in the direction of such studies,papers etc.

Dear Alan,
I know. Money changes everything.

~Deb

sjobs said...

All I can say is that this summer was a terrible experience for me. I wasn't sleeping, was sad all the time and the only reason I got out of bed was for my daughter.

When I went in for my annual physical, my doctor thought I could be depressed. Not me, life is good. It turns out he was right and ever since I have been medicated, the world is a different place.

Thanks for keeping us all informed.

Mary

CrackerLilo said...

A reminder that the brain is an organ like any other.

I have a question for you. I've been taking 10 mgs of Lexapro for the past 18 months. I'm getting bad headaches and getting cranky a lot lately, and my old social anxiety seems to be coming back. Is this a sign that I finally need to up the dosage, or that it's not working anymore?

Rose said...

Anything that will help folks who suffers from this....

Id it is said...

I wonder how soon it'll be available outside of the USA...

dawn said...

so far, it looks like its only used here in canada for epilepsy,from what i can see. thats a shame:(

Rue said...

*shiver* I don't know...I mean it doesn't sound as invasive as Electro-Convulsive Therapy but still...it's seems frankenstienish. Not to mention scarey.

tombotts.com said...

Post again.

jane said...

Hi Dr. Deb,
I've moved my blog to a new domain, if I'm on
your blog list or blogroll, would you please update
it to: http://www.janelovestarzan.com. My other
blog is no longer active.
Fondly,
Jane

Kim said...

I once saw ECT take an elderly, anorexic, flat-affect, depressed female and turn her into a social, smiling, functional woman who ate normally and was concerned about her personal hygiene.

I think this vagal nerve stimulator is an unbelieveable invention, if effective.

Any cardiac or blood pressure issues?

The vagus nerve enervates the stomach, can drop your pulse and your blood pressure. I wonder how they can selectively stimulate it without side effects...

Dr. Deborah Serani said...

Dear Mary @ sjobs,
Medication can be a life saver for many. So glad you were proactive about your depression.

Dear Crackerlilo,
I am not a medical doctor so I often refrain from asnwering direct questions about medication. It's best to ask your treating doctor. Your question is a very good one and I am sure h/she can answer it for you.

Dear Rose,
Yup, I'm with you on that.

Dear Id It Is,
I don't know about it. But the company can be contacted directly. The link I gave on the post can get a person there.

Dear Dawn,
Hmmm....that is a shame.

Dear Rue,
I can understand the Frankenstein symbolism. It is so refined nowadays.

Dear Tombotts,
Patience is a virtue.

Dear Jane,
Will do.

Dear Kim,
I don't know the specificis. I am just the messanger. But those questions have been asked and I believe there are controls for those concerns.

~Deb

Anonymous said...

Dr. Deb

I live in Hamilton, Ontario, Canada and have beenon disability for clinical depression for about 12 years now. I have tried almost all antidepressents and they are becoming ineffective. I am 42 now with no children or husband. I am so tired of fighting. Last month I took a small overdose as this depression effects every part of me.I have been treated with antidepressents since I was 14 years old. I was wondering if you know of any Canadian studies being done because I could never afford this treatment. As I have gotten older it is like I am half dead already. I don't even have a psychiatrist anymore but work with my family doctor. Although, I have seen many I feel that perhaps I have seen too many. I grab onto things to hold onto hope that I will find something that works oneday. I know there is no quick fix I have had this depression probably all of my life and it has affected every aspect of it. If you have any information that you think could help me I would appreciate it.

Sincerely,

Kelly O'Neill