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Re: Vagus Nerve -- on a more serious note

Posted by dj on October 20, 1999, at 1:01:36

In reply to Vagus Nerve Stimulation, posted by Janice on October 19, 1999, at 22:25:20

Some excerpts from a New Yawk Times article:

July 27, 1999

Some Still Despair in a Prozac Nation

"...Like many people who suffer from depression, Ms. McGann, who is 37, has heard the public service announcements that proclaim her condition to be eminently treatable. She has seen the advertisements for Prozac and Zoloft and Luvox and a dozen other antidepressant drugs, old and new, promotions that show smiling men and women happily going about their lives. She can cite the studies showing that certain types of psychotherapy are effective for depression, especially when combined with antidepressants.

Ms. McGann's own experience, however, has been slightly different: In the five years since she her latest battle with the illness began, she has tried virtually every treatment the mental health field has to offer -- and not one of them has worked. Not drugs, either singly or in combination, not psychotherapy, not the electroshock therapy she received in 1995.

Recently, she had a device implanted under her collarbone that delivers electrical stimulation to the vagus nerve in her neck -- a procedure that has proved effective for some forms of severe epilepsy, and that Columbia University researchers are trying on an experimental basis in depression. But so far that treatment, too, appears to be failing. As a last resort, she said, she may decide to undergo a cingulotomy, a form of brain surgery in which fibers deep in the frontal lobe are severed...

Treatment-resistant depression is a continuum," said Dr. Harold Sackheim, chief of biological psychiatry at the New York State Psychiatric Institute. "Some people don't do that well with first treatment, but they respond to the second. Some will go 20 years and nothing helps them."

In the most dire and intractable cases, some physicians turn to experimental approaches like vagus nerve stimulation, which Dr. Sackheim's institute is studying as a treatment for refractory depression, or even cingulotomy, which has been found to help some people for whom nothing else works.

Researchers know little about why some people respond fully to antidepressant treatment and others do not. In some cases, the difference may lie in brain structure or brain chemistry: different people respond differently to any type of drug.

But some patients who are deemed refractory may also simply have received inadequate treatment, taken a drug at a dosage too low to be effective or discontinued the medication before the four to six consecutive weeks most experts consider a reasonable trial.

Complicating things further, many patients who do not respond to antidepressant treatment are not just depressed, but have other difficulties as well: medical or neurological conditions, for example, or other psychiatric problems like substance abuse, panic attacks or personality disorders. "The frustration," Dr. Kupfer said, "is that there are a number of different factors where the final common denominator is that people are not feeling better."

And while experts agree that most types of severe or recurrent depression have their roots in biology, psychology plays a role as well.

Dr. Judith Nowak, a psychopharmacologist and psychoanalyst in Washington, said that, in her experience, some people who did not respond to antidepressants or combinations of drugs had complicated life problems that could "only be understood, managed and corrected through psychological intervention."

"I've seen several people who had lifelong refractory depression and got caught in a loop of many experimental medication regimens," Dr. Nowak said, "But it really was through good psychotherapy that they were helped." ...




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