Therapy

A New Hope for Depression

Vagus Nerve Stimulation Therapy

From: The Stamford Advocate, Stamford, Conn.

Date: July 17, 2007

Jul. 17–Claire Kolff’s depression began about 18 years ago. Since then, this married mother of three has tried talk therapy, about 20 different medications, myriad drug combinations and two rounds of electroconvulsive therapy, but her feelings of hopelessness continued.

Her diagnosis: Treatment-resistant depression. While TRD has no widely accepted definition, psychiatrists often characterize it as long-term chronic or recurrent depression that is unresponsive to various antidepressant treatments.

“Depression for me is like being in a very deep hole and not seeing any light at the end of the tunnel,” says the 60-year-old Fairfield resident, interviewed recently in the Stamford office of her psychiatrist, Dr. Justin O. Schechter. In March 2006, Kolff’s persistent depression was treated with a new therapy that soon brought positive results.

With Schechter’s recommendation, she was approved as a candidate for VNS (vagus nerve stimulation) Therapy. During an outpatient procedure, a neurosurgeon implanted a small pacemaker-like device in Kolff’s chest. It is an FDA-approved, battery-operated mechanism that intermittently emits mild electrical impulses to her brain through the neck’s vagus nerve.

Considered the body’s information super highway, the vagus nerve links to the brain and other major organs. Although it’s not clear how the device helps ease depression, Schechter says what is known is that VNS Therapy “can provide electrical impulses in a safe, controlled way, and that can have a positive effect on mood.”

Once Kolff’s surgical wound healed a few weeks after surgery, Schechter turned on and programmed the device to set the amount of electrical stimulation to her brain.

Month by month, her spirits slowly began lifting. Kolff now cooks and goes food shopping, once impossible chores. “There was a time I couldn’t do it. I would just sort of freak out in the (supermarket) aisles.”

She was often unable to shower and get dressed, and spent a lot of time in bed as her kids were growing up. Her children were cared for by her husband and other caretakers. She had suicidal thoughts, although she never acted on them. Her despondency caused her to miss a daughter’s high school graduation.

Although she is still on six medications prescribed by Schechter and continues talk therapy sessions with a psychologist, Kolff says VNS Therapy has brought her a new lease on life. “I have my (down) moments, don’t we all? e But I am a lot happier e my family is happier e I never feel as bad as the way I used to.”

Schechter calls patients’ response to this therapy “good day, bad day. It’s very nonlinear. You want to gradually move into the direction where you have one bad day and six good days. It’s a jagged curve that gradually moves in a more positive direction.”

The intensity of electrical stimulation can be adjusted by Schechter as needed, depending on how Kolff is feeling. In time, he hopes to pare down her medication.

While not everyone experiences side effects from VNS Therapy, Kolff gets a temporary hoarseness when the electrical stimulation occurs while she is talking.

VNS Therapy is manufactured by Houston-based Cyberonics Inc. and was first approved by the FDA in 1997 as an adjunctive therapy to control seizures in treatment-resistant epileptic patients older than 12. Studies showed improvement in the moods of these patients after VNS. In January 2005, VNS received FDA approval for continuing or recurring depression in patients 18 and older who do not sufficiently respond to four or more antidepressant treatments.

“Unfortunately, there’s sort of a kindling effect you have with depression,” Schechter explains. “The more episodes you have, the more likely you are to have subsequent episodes.” With each episode, the possibility of improvement is reduced. Individuals resistant to treatment are at greater risk of becoming even more resistant. This is why it is important to diagnose and treat depression early.

Since its FDA approval for treatment-resistant depression, VNS Therapy has been shown in numerous studies to produce significant improvement in 50 percent of patients undergoing this treatment, says Cyberonics Chief Executive Officer Dan Moore. And one of six patients, he adds, will become depression free.

“e Of the patients who responded to VNS Therapy, either early or later in treatment, the majority continued to experience significant clinical benefit for up to 24 months. VNS Therapy is the first and only treatment for TRD to demonstrate such long-term improvements.”

To be eligible for the device, individuals must be recommended by their psychiatrists. Because the adjunctive treatment is relatively new for TRD, Schechter says patients require multiple layers of approval for medical insurance coverage. It took Kolff five months to be approved. Her medical procedure and related services totaled ,000 and were fully covered by insurance. Schechter believes approval will get easier as increased numbers of patients seek this specialized therapy.

“It’s not your traditional type of treatment where you go in and get fixed quickly,” he says. “One has to be pretty courageous about doing this. It requires courage, persistence, patience and working closely with your doctors. Claire is great in being willing to do that. It’s a long-term commitment.”

Source: Highbeam Research

Copyright (c) 2007, The Stamford Advocate, Conn.

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