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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Nickengland on April 2, 2005, at 11:29:47
Does anyone know much about Vagus Nerve Stimulation?
I read that it was originally used for epilepsy in the 1990's. The people who had the implant reported that it improved their mood, so then it went through some open trials for depression and is now licenced to treat depression? - (not 100% sure on that one, but think im right)
Seeing how it is beneficial for epilepsy and people with bipolar take epileptic medications I wonder how useful this could be to people with bipolar depression without pushing their mood to far up - maina/hypo?
From what I see it is available in the uk, but only privitely in London and on the NHS in Dundee. As for the US im not to sure but know it is used over there.
Posted by Spriggy on April 2, 2005, at 11:49:21
In reply to Vagus Nerve Stimulation Anyone?, posted by Nickengland on April 2, 2005, at 11:29:47
I had an intelligent friend waay back who was a geneticist. He swore by this "Vagus Nerve Stimulation" for all sorts of things; including autism (my son is autistic).
I've often wondered if it would help.
A girl in my church has severe grand mal seizures. She had it done and it helped SOME but not completely.
It would be interesting to read statistics about how it improves depression.
What about anxiety? My main symptom is anxiety.
Posted by WeeWilly on April 2, 2005, at 12:49:04
In reply to Re: Vagus Nerve Stimulation Anyone?, posted by Spriggy on April 2, 2005, at 11:49:21
For depression the effecacy of VNS appears to be meager. In my opinion the money and effort put into this treatment was poorly spent. I recall reading a book " The pinball effect" which describes the history of discovery as random hits and misses. VNS technology seems so crude. Every process in us is biochemical. You would think we now have the diagnostic tools available to decipher how this biochemistry functions, instead of blindly throwing electicity or antideppressent chems at us without knowing what the mode of action is. I am just astonished how primitive the treatments and understanding of mood disorder are to date. One can only hope we will emerge from this medical dark age soon.
Posted by denise1904 on April 2, 2005, at 13:51:52
In reply to Vagus Nerve Stimulation Anyone?, posted by Nickengland on April 2, 2005, at 11:29:47
Hi Nick,
I was considering VNS about two years ago. I spoke to a lady in Ireland who'd had it done and she swears by it, she noticed an improvement in her mood after four weeks. However, jerrympls on this board had it and did not seem to find it helpful so you never can tell.
I got the contact details for the trial in England from the Irish Lady and went to see one of the Docts in London who was conducting it and he was really nice. We decided though against it for cosmetic reasons (it tends to stick out). But I'm now thinking of pursuing this treatment afterall can't see what I've got to lose. I am first of all though trying to find out about Magnetic Seizure Therapy.
Kind Regards......Denise
Posted by Lydia on April 2, 2005, at 14:12:22
In reply to Re: Vagus Nerve Stimulation Anyone?, posted by WeeWilly on April 2, 2005, at 12:49:04
I found this article the other day on Medscape, but I can't seem to get a link to work, so here it is, copied and pasted:
"Vagal Nerve Stimulation Can Work for Refractory Anxiety"
May 29, 2003 (Santa Cruz, California) — A small series of patients with encouraging response to vagal nerve stimulation highlights the promise this technique holds for anxiety conditions that resist other forms of treatment. Seven of 10 patients improved after the treatment, as measured six months after a 10-week trial, which was presented last week at the 156th annual meeting of the American Psychiatric Association in San Francisco.
Participants in the open trial were four men and six women. Seven patients had obsessive-compulsive disorder (OCD), one had panic disorder, and three had posttraumatic stress disorder (PTSD).
Response was defined as more than 50% improvement on the Hamilton Anxiety Scale for all patients, and, for the OCD patients, more than a 25% improvement on the Yale-Brown OC scale.
Mean duration of illness was 10 years. On average, the patients had tried 18 different medications for their problems. Use of medication continued through the trial.
Mark Pollack, MD, a study investigator, told Medscape in an interview that "these were seriously ill patients, to get any response is hopeful." Dr. Pollack, associate professor of psychiatry at Harvard School of Medicine in Cambridge, Massachusetts, said the findings "are potentially interesting [but] we need more experience with it before it's widely used in the anxiety disorders."
Philip Muskin, MD, professor of clinical psychiatry at Columbia University in New York City, commented for Medscape that, while the stimulation is "an interesting therapeutic avenue," it is not "first-, second-, or even third-line treatment" at this point.
These early findings do point the way to further research with vagal nerve stimulation, Dr. Muskin said, adding, "Trial and error in the research will hopefully reveal the correct pattern of electrical stimulation that will yield therapeutic results."
"It may take a decade but I think it will probably succeed," Dr. Muskin said.
He noted that vagal nerve stimulation "may stimulate the brain to achieve an anti-anxiety effect in ways similar to breathing exercises such as those used in yogic breathing." Dr. Muskin presented data on yogic breathing at the APA meeting.
Vagus nerve stimulation is approved for use in refractory partial onset seizures. It also shows promise in depression.
The study was funded by Cyberonics.
APA 156th Annual Meeting: Abstract NR768. Presented May 22, 2003.
Reviewed by Gary D. Vogin, MD
Roberta Friedman, PhD, is a freelance writer for Medscape.
Posted by Nickengland on April 4, 2005, at 7:43:40
In reply to Re: Vagus Nerve Stimulation Anyone?, posted by Spriggy on April 2, 2005, at 11:49:21
Hi Spriggy,Yes its definately proven that it can help in both epilepsy and depression.
http://vnsdepression.com has lots of information about it and a forum with a couple of people who have had it. The british girl says it has changed her life. Although like most thing I doubt this is the case for every body whos had it.
Im really not at all sure if it would help with anxiety. The side effects seem to be that everytime its switched on (30 seconds for every 5mins) you get a horseness in your voice.
Very interesting device, but quite a big step to take and can be very expensive!
Im bipolar so would have concerns that if its could for depression - could it push you up too far...
Kind regardsNick
Posted by Nickengland on April 4, 2005, at 7:49:00
In reply to Re: Vagus Nerve Stimulation Anyone?, posted by WeeWilly on April 2, 2005, at 12:49:04
I totally agree with you. Psychiatry is definately in its early days and I for one can't wait for the day that instead of treating the symptoms - they find the cure...But I fear that day will not be in this life time, but then again who knows?Kind regards
Nick
Posted by Nickengland on April 4, 2005, at 8:29:18
In reply to Re: To NickEngland, posted by denise1904 on April 2, 2005, at 13:51:52
Hi Denise,
Very interesting you should mention an Irish lady...Was her name Shelagh by any chance?
I only came across this subject a couple of days ago but knew of it before. I went on a site called vnsdepression.com and spoke to an irish lady on a forum there whos had it...could be the same person!
If you was to pursue this would go via the NHS or pay privitely?
I suffer mainly from depression but mood does have the tendency to go up (I've been now diagnosed with bipolar) I wonder if this treatment would not be too effective for me because it could push my mood to far up..
Whats Magnetic Seizure Therapy?
Kind Regards
Nick
Ps That lady is now doing very well and currently lives in Spain.
Posted by Nickengland on April 4, 2005, at 8:34:28
In reply to Re: Vagus Nerve Stimulation Anyone?, posted by Lydia on April 2, 2005, at 14:12:22
Thanks Lydia,
I found this one too..
VAGUS NERVE STIMULATION FOR UNIPOLAR AND BIPOLAR DEPRESSION
In July 1998, surgeons implanted a pacemaker-like device into the chest of a bipolar patient with severe depression. The implement sends an electrical pulse up a wire into the vagus nerve in the neck at the base of the brain. The treatment, vagus nerve stimulation or VNS, has been in use for epilepsy patients in Europe since 1994 and the US since 1997. Within eight weeks, the patient moved out of his parents’ house and found a job. He did, however, cycle into an irritable mania. Nevertheless, the results were encouraging enough to proceed with a pilot study.
Cyberonics, the Houston company that developed and manufactures the device, first approached Mark George MD, a psychiatrist and neurologist at the Medical University of South Carolina to see if there might be a wider application for VNS. Because epilepsy meds also work for bipolar patients, Dr George thought there might be a parallel, especially when PET scans of VNS patients revealed activity in the prefrontal cortex, cingulate gyru, and amagdyla, all involved in mood. Dr George recruited three other researchers - Lauren Marangell MD at Baylor College of Medicine, A John Rush MD of the University of Texas Southwestern Medical Center, and Harold Sackeim PhD at Columbia University - and together they enrolled 30 depressed unipolar and bipolar patients for an open trial, and 30 more patients a year later.
The patients had been in major depression for more than six years and had failed 16 treatments - including antidepressants, mood stabilizers, and ECT - with mean Hamilton Depression scores of 36.8. Patients were allowed to stay on their current medications According to Dr George, the 60 patients represented "maybe the most ill cohort ever published."
Thirty percent of the patients responded after 12 weeks. A "response" is measured as at least a 50 percent improvement in symptoms. Patients who had failed on two or three antidepressants fared best. Those who failed on more than seven antidepressants did not respond at all. Twenty-one percent of all the patients remitted - that is, they achieved a symptom-free or near symptom-free state - a finding that took the researchers by surprise: "I’ve been treating these kinds of patients for more than a decade and I’ve never seen anything like it" said Dr George.
The bipolar depressed patients had similar results as the unipolar depressed patients. One bipolar patient and one unipolar patient switched into hypomania, causing one drop-out amongst the entire 60.
By way of comparison, clinical drug trials typically include patients with Hamilton Depression scores as low as 16 or 18. In general, seventy percent of those in drug trials respond, but only 30 percent of the responders actually achieve remission. Drop-out rates can be as high as 40 percent.
After one year, 41 percent of the original 30 patients had responded, and 26 had remitted. At least 90 percent of the responders were still responding after one year. In December 2001, at the annual meeting of the American College of Neuropsychopharmacology, the authors presented their latest findings, reporting that after two years response rates had climbed to 54 percent.. Dr George did not rule out the fact that the improved numbers over the course of time could have been due to the patients’ depressions independently abating, but he also pointed out that it is unlikely a placebo response could have been maintained for two years.
Side effects included tremulous voice and shortness of breath, both tolerable and receding over time.
The pilot study data was enough for European and Canadian authorities to approve VNS for treatment of depression. A 240-patient double blind study (in which half the devices were switched on and the other half left off) is nearing completion, and the results could lead to FDA approval in early 2002. The FDA has VNS on a fast track review process. Dr George is cautious about raising false hopes, noting "the scientist in me is skeptical until we receive double blind data."
The VNS device was invented by Jake Zabara PhD, a retired neurophysiologist at Temple University, who found that the vagus nerve transmitted signals up to the brain rather than down to the body as once thought. The device has now been implanted in 15,000 epilepsy patients worldwide. Cyberonics keeps a long-term patient data registry, and one interesting statistic from that registry is that even the nonresponders (still on their meds) show quality-of-life improvements such as alertness and better memory. Since many bipolar patients use these same meds, this raises the possibility that VNS could be used to reduce the sedating side effects of those drugs.
Cyberonics is also sponsoring studies of VNS for the treatment of Alzheimer's, anxiety, and obesity.
The battery in the device lasts about five years. The implant surgery is an outpatient procedure lasting about an hour. The patient can adjust the device with a magnet, and the doctor can make corrections with a wand attached to a computer. Robert Cummins, CEO of Cyberonics, foresees a day when settings can be fine-tuned based on a patient’s fMRI. "We have only begun to scratch the surface," he said.
The device, including surgery, can cost up to $20,000, but the company has funded a study about to be published in the Journal of Clinical Psychiatry showing that a patient who has had either two failed treatments, a suicide attempt, or a hospitalization will incur costs of $41,000 a year over the next five years. For a chronically depressed patient who has not been hospitalized, the cost is $9,000 a year. Those kind of numbers make it likely that health care providers will pick up the tab for the treatment.
The double-blind study results are expected to be announced at the end of February.
Posted by Lydia on April 4, 2005, at 20:40:56
In reply to Re: Thanks Lydia, posted by Nickengland on April 4, 2005, at 8:34:28
Your article kicks my article's a ss :)
Posted by Nickengland on April 5, 2005, at 5:52:01
In reply to Re: Thanks Lydia » Nickengland, posted by Lydia on April 4, 2005, at 20:40:56
LOL : )
Posted by EERRIICC on April 5, 2005, at 22:02:05
In reply to Vagus Nerve Stimulation Anyone?, posted by Nickengland on April 2, 2005, at 11:29:47
I have one in right now. The trial was a failure and it has been off for about a year. When it was initially turned off I had severe stomach pain for a couple of months.
Posted by reefer on April 7, 2005, at 18:50:17
In reply to Vagus Nerve Stimulation Anyone?, posted by Nickengland on April 2, 2005, at 11:29:47
I went to a acupunture clinic and had vagus nerve stimulation done there by needles. I'm afraid of needles even if they aren't injecting anything into me so the only thing it did to me was make me feel uncomfortable for an hour and really relieved when they took the damn needles out of my freakin' ears. I did it 5 times. They sad that if i didn't get any effect after that it wouldn't work and it didn't.
Posted by LifeTime on May 18, 2005, at 17:02:57
In reply to Vagus Nerve Stimulation Anyone?, posted by Nickengland on April 2, 2005, at 11:29:47
Dear Nick,
I was searching the web and came across your post and those of the other participants. My name is Herb and I am the gentlemen who established the www.vnsdepression.com Website to share information regarding the VNS Therapy.
As another gentleman posted here, from his personal experiences, the therapy is obviously not a panacea and as anyone who is familiar with TRD (Treatment Resistant Depression) and/or mood disorders is aware, there are no cures and there is no panacea with any medications, treatments and/or therapies. What we in essence have is a new and innovative therapy on the verge of US FDA approval that offers the patient and/or their support persons a new treatment option. With the education of the patient and in consultation with a trusted, compassionate, knowledgeable and licensed health care practitioner(s) there is the opportunity to try another therapy in lieu of other failed therapies.
There is no way of predetermining who will or will not benefit from the therapy nor am I endorsing this therapy or for that matter any therapy although I do advocate for education of the patient and all therapy options. I am a very experienced and long time support person and health care advocate for my wife who has suffered from TRD. As happens, the reason for establishing the site is the fact that I have accumulated through the years much knowledge as it relates to my spouse’s illness and in particular over the past 5 or more years that she has participated in the VNS Therapy studies for depression knowledge of the therapy and my interest in educating and sharing with others.
My wife has been almost continuously depression free for about 4 years without the use of psychotropic medications for purposes of depression.
If you have a chance stop by and visit the Website and some of the information I’ve accumulated and then come over and join the message forum. Again, we can be found at http://www.vnsdepression.com or any of the search engines just search for “vnsdepression.”
Whatever therapy option one chooses, I wish you all a speedy ascent toward wellness.
Warmly,
Herb.
This is the end of the thread.
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