Psycho-Babble Medication Thread 55617

Shown: posts 1 to 8 of 8. This is the beginning of the thread.

 

spinal surgery for depression ?

Posted by vince on March 5, 2001, at 11:04:27

A while back one of the news magazine shows (60 Minutes or similar) done a report on a surgery that could help depression. It has been a while and I can't remember any of the details but according to the report one of the upper vertebrate in the neck could be impinging a nerve (vagus nerve maybe, I don't remember now and I know nothing about anatomy). This happens if the opening that the nerve passes through is too small. This could be detected with an MRI and could be corrected with surgery by increasing the size of the opening relieving the presure on the nerve. I haven't heard anything about it since.

Anyway, I'm just wondering if anyone knows what I'm talking about and has any information about this procedure.

Vince

 

Re: spinal surgery for depression ? » vince

Posted by Cece on March 5, 2001, at 19:56:54

In reply to spinal surgery for depression ?, posted by vince on March 5, 2001, at 11:04:27

> A while back one of the news magazine shows (60 Minutes or similar) done a report on a surgery that could help depression. It has been a while and I can't remember any of the details but according to the report one of the upper vertebrate in the neck could be impinging a nerve (vagus nerve maybe, I don't remember now and I know nothing about anatomy). This happens if the opening that the nerve passes through is too small. This could be detected with an MRI and could be corrected with surgery by increasing the size of the opening relieving the presure on the nerve. I haven't heard anything about it since.
>
> Anyway, I'm just wondering if anyone knows what I'm talking about and has any information about this procedure.
>
> Vince

I was interested in this when I read the post also, as it supposedly "cured" CFIDS and fibromyalgia (i have the latter). Today, I asked my pdoc about it- he is very open-minded to new possibilities. He said that he had heard about it when it first was aired, and was very skeptical. He said that if something new was really medically of interest, that it would be written up in a medical journal for peer review, not aired on a TV show. He also said that patients with CFIDS had been studied SO extensively for any irregularities at all, that it would likely have turned up in those studies.
Not necessarily the final answer, but an opinion that I respect from my experience with this doc.
The url for the info about the show is: www.abcnews.go.com/sections/living/DrJphnson/drjohnson_3.html

Cece

 

Re: Vagus Nerve Stimulator... » vince

Posted by dj on March 5, 2001, at 21:08:13

In reply to spinal surgery for depression ?, posted by vince on March 5, 2001, at 11:04:27

>...one of the upper vertebrate in the neck could be impinging a nerve (vagus nerve maybe, I don't remember now and I know nothing about anatomy). This happens if the opening that the nerve passes >through is too small...

I don't know about the above but the VNS is a device like a heart pacemaker, originally developed to help with epilepsy which I believe is still being tested as a tool for possibly dealing with treatment resistant depression. There have been posts on this site before and a search of the archives will find them for you. A search with http://www.google.com or other search engines will also bring up a variety of references such as this one:

Re: Anyone in vagus nerve study? » anita
... Hi, > > I have an opportunity to join a vagus nerve stimulator study (for depression)
and I'm just wondering if anyone here has done this yet. Does anyone ...
www.dr-bob.org/babble/20000619/msgs/38279.html - 12k - Cached - Similar pages

or this one:

Vagus Nerve Stimulator successful for depression
... Vagus Nerve Stimulator successful for depression. DALLAS - December 15, 1999 -
A nationwide clinical trial has shown Vagus Nerve Stimulation (VNS), an ...
www.eurekalert.org/releases/utsw-vns121499.html - 6k - Cached - Similar pages

A bit from the latter:

"Results of the VNS pilot study showed that 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, according to the Hamilton Rating Scale for Depression, said Dr. A. John Rush, vice chairman for research in the Department of Psychiatry at UT Southwestern Medical Center at Dallas and the study's lead investigator. Half the patients also had at least a 50-percent improvement on the Montgomery Asberg Depression Rating Scale. The condition of several patients improved so substantially that they were able to return to work or other normal activities. All the patients who responded to the treatment have continued to do well.

Results of the 30-patient study were published online today in Biological Psychiatry in abstract form. Besides UT Southwestern, the clinical study was conducted at Medical University of South Carolina College of Medicine, Charleston; Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York; and Baylor College of Medicine, Houston.

Approximately 18 million Americans suffer from depression, about 1 million of whom have severe treatment-resistant depression.

"While the results are preliminary, since the study included only 30 participants, they are extremely encouraging and point toward the importance of conducting further research in this treatment area," said Rush.

He also said that test results indicate that the treatment may have the potential to be used as an alternative to electroconvulsive therapy for some patients.

"For the first time in years, I can feel joy, real joy," said Joanne Tesoriero, a Texas grandmother treated during the pilot study and a lifelong sufferer of chronic depression. "VNS has enabled me to do what years of drugs and even ECT has not. I can fully appreciate my family, my children and my grandchildren. It is the best thing I have ever done."

The Food and Drug Administration has approved an expanded, 94-patient trial of VNS at up to 15 medical centers to begin next year. Houston-based Cyberonics, which helped fund the research, developed the treatment and devices. The firm has said that the study may ultimately involve 200 patients at up to 20 medical centers. The NCP System used to deliver VNS is not currently approved for the treatment of depression.

"The vagus nerve carries information to many areas of the brain that control mood, sleep and other functions," Rush said. VNS treatment involves stimulating the left vagus nerve in the neck with a series of miniscule electrical pulses traveling through a small surgically implanted wire attached to a pulse generator in the chest. The pulse generator delivers stimulation to the vagus nerve in individualized therapeutic "doses."

Study patients were required to be from 18-70 years of age and to be suffering from non-psychotic major depression or be in the depressed phase of bipolar, or manic-depressive, illness. Participants' current episodes had to have been more than two years in duration, or they had to have suffered at least four different episodes. They also had to have failed to respond to at least two medication trials in the current episode. Patients who were currently taking psychotropic medications were allowed to continue on their prescriptions.

Following surgery to implant the pulse generator in the upper chest and tunnel the wires into the neck, where they were wrapped around the left vagus nerve, patients received no electrical stimulation while they healed, a two-week period for most.

"At the end of that time, the levels of electrical impulses were adjusted for individual patient tolerance, this process also taking two weeks," Rush said. Then the patients received VNS for an eight-week period, each receiving his or her individually tolerated dose."

Make of it what you shall. For the 40 percent who saw substantial improvement during that period, good news, for the 60% who didn't (though we are dealing with a small sample here) it's gotta be a bummer.... but what about over a longer period and more recent studies. I'll leave it for you to seek those out and perhaps post some results here...

dj


 

Re: CFIDS, huh???? » Cece

Posted by dj on March 5, 2001, at 21:13:53

In reply to Re: spinal surgery for depression ? » vince, posted by Cece on March 5, 2001, at 19:56:54

> supposedly "cured" CFIDS

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS)which I only found through a quick search online. Acronymns ring true for those who use them constantly but for the rest of us they are a mystery..

> The url for the info about the show is: www.abcnews.go.com/sections/living/DrJphnson/drjoh >nson_3.html

Unfortunately, that url no longer seems to work...

 

Re: VNS - ECT connection, from another study, and.

Posted by dj on March 5, 2001, at 21:42:35

In reply to Re: Vagus Nerve Stimulator... » vince, posted by dj on March 5, 2001, at 21:08:13

Some more comments from another 1999 VNS study of 30 folks with some similar results in stats:
http://my.webmd.com/content/article/1728.53467

Nerve Stimulator Appears Effective in Treatment-Resistant Depression

Response May Increase With Time

By Peggy Peck
WebMD Medical News

Dec. 15, 1999 (Cleveland) -- An implantable device that is about the size of a stopwatch may put a stop to depression in patients who have failed treatment with antidepressants or shock therapy. Depression affects about 18 million Americans, but about 1 million of those people have severe treatment-resistant depression that lasts for years and is a disabling condition.

The experimental treatment works by way of a generator implanted in the chest. Wires attach the device to the vagus nerve, which runs from the neck into a brain region believed to be important for regulating mood. The generator then sends tiny electric shocks to the nerve.

The treatment, called a vagus nerve stimulator, is already FDA-approved for severe epilepsy. But the results of a multi-center study on its effect on depression were presented at the annual meeting of the American College of Neuropsychopharmacology in Acapulco earlier this week and published online Wednesday by Biological Psychiatry.

"Typically the surgery is done as an outpatient procedure that takes about an hour or two," says lead researcher A. John Rush, MD.

Rush, vice chairman for research in the department of psychiatry at the University of Texas Southwestern Medical Center in Dallas, tells WebMD that 40% of the 30 patients enrolled in the open treatment trial had at least a 50% improvement in their depression at the end of an eight-week course of treatment.

Rush says, "We have followed some of these patients for 10 months now, and we can report that those who responded during the early phase have held the response, and some patients who didn't respond during the eight-week trial responded later. So the long-term results are actually slightly more optimistic than the eight-week results that were reported in this paper."

The results are particularly compelling given the severity of depression, he says. "Twenty-one patients had major depressive disorder and nine were bipolar [formerly known as manic depressive]," he says. More than half of the patients had received ECT-- the so-called electro-shock therapy -- and all the patients failed to respond to at least two robust antidepressant medication trials.

"A typical side effect would be a raspy-sounding voice during stimulation, because the [vocal cords are] also affected," says Rush. The electrical current is on for 3 seconds and then off for 5 minutes, and this cycle is constant 24 hours a day, Rush says. "At the same time, the patient is maintained on the baseline medication regimen. This is an unusual approach for psychiatry, but we are considering this as an add-on therapy," he says.

Although he is enthusiastic, Rush emphasizes the preliminary nature of the findings. Asked to comment on the study, Thomas Thompson, MD, director of the ECT program at Wesley Woods Geriatric Hospital in Atlanta and assistant professor of psychiatry at Emory University School of Medicine, echoed that cautious note. Thompson tells WebMD, "This is very preliminary work, and the findings need to be replicated in a larger study. A lot more work still needs to be done."

If the results are proven in larger studies (the FDA has given approval to enroll another 30 patients in the ongoing trial), Rush says that the stimulator may prove a good alternative to ECT. He says that he and his fellow researchers did some testing that indicates the vagus nerve device may actually improve some mental functioning.

One of the main criticisms of ECT is that it sometimes leaves patients with sluggish responses and impaired memory. Rush says, however, that the improvement may be related to the improvement in depression.

That explanation makes sense to Thompson, who says that although ECT is associated with some changes in mental functioning around the time of the treatments, "We actually see improvements when we retest after treatment if there has been an improvement in the depression." He says that the vagus nerve stimulator may work the same way.

Using the treatment for depression is experimental, but Rush estimates that if it becomes an approved therapy the cost will be "about $10,000 to $12,000 for the device and about $4,000 to $5,000 for the surgery." In this study, all surgeries were "done by neurosurgeons who have implanted [the vagus nerve stimulator] for epilepsy," Rush says.

The study was partially funded by Cyberonics of Houston, manufacturer of the stimulator.


 

Re: spinal surgery for depression ? » Cece

Posted by vince on March 5, 2001, at 23:27:37

In reply to Re: spinal surgery for depression ? » vince, posted by Cece on March 5, 2001, at 19:56:54

> > A while back one of the news magazine shows (60 Minutes or similar) done a report on a surgery that could help depression. It has been a while and I can't remember any of the details but according to the report one of the upper vertebrate in the neck could be impinging a nerve (vagus nerve maybe, I don't remember now and I know nothing about anatomy). This happens if the opening that the nerve passes through is too small. This could be detected with an MRI and could be corrected with surgery by increasing the size of the opening relieving the presure on the nerve. I haven't heard anything about it since.
> >
> > Anyway, I'm just wondering if anyone knows what I'm talking about and has any information about this procedure.
> >
> > Vince
>
> I was interested in this when I read the post also, as it supposedly "cured" CFIDS and fibromyalgia (i have the latter). Today, I asked my pdoc about it- he is very open-minded to new possibilities. He said that he had heard about it when it first was aired, and was very skeptical. He said that if something new was really medically of interest, that it would be written up in a medical journal for peer review, not aired on a TV show. He also said that patients with CFIDS had been studied SO extensively for any irregularities at all, that it would likely have turned up in those studies.
> Not necessarily the final answer, but an opinion that I respect from my experience with this doc.
> The url for the info about the show is: www.abcnews.go.com/sections/living/DrJphnson/drjohnson_3.html
>
> Cece

Cece,

I'm sure that this is the story that I was thinking of, but for some reason I had in mind that the surgery could potentially help some cases of treatment resistant depression in patients with abnormal findings on MRI’s of the base of the skull and neck. Thanks for the url, I had to correct the typo (jphnson - > johnson), but the info is still out there.

Vince

 

Re: CFIDS, huh???? » dj

Posted by Cece on March 6, 2001, at 0:11:26

In reply to Re: CFIDS, huh???? » Cece, posted by dj on March 5, 2001, at 21:13:53

Sorry, I got a letter wrong, try this (I just downloaded it a few days ago):
www.abcnews.go.com/sections/living/DrJohnson/drjohnson_3.html
Cece

> > The url for the info about the show is: www.abcnews.go.com/sections/living/DrJphnson/drjoh >nson_3.html
>
> Unfortunately, that url no longer seems to work...

 

Re:No worries... » Cece

Posted by dj on March 6, 2001, at 5:31:43

In reply to Re: CFIDS, huh???? » dj, posted by Cece on March 6, 2001, at 0:11:26

I picked up on that from Vince's post above you. Because it was a lengthy url I assumed you had cut and pasted it and didn't look for spelling errors.... As it turns out there was nothing about the vagus nerve in the article, unless that is the nerve which is impeded...


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