Drug Free Treatment for Depression

What do you do if you have chronic clinical depression and drugs, psychotherapy and even electroconvulsive therapy are simply not working? There is a relatively new alternative treatment available that will not require you to test yet another drug with all its negative side effects only to find it doesn't work for you. On July 15, 2005, the FDA approved vagus nerve stimulation for the treatment of chronic or recurrent depression that has not had an adequate response to four or more adequate antidepressant treatments. So what is vagus nerve stimulation and why haven't you heard about it you may ask?

First of all lets define the vagus nerve, as most people don't have a clue what it is. The vagus nerve is the primary communication pathway between your brain and such major organs as your heart, lungs and intestines. There's one vagus nerve on each side of your body. The nerve runs from your brainstem through your neck and down to your chest and abdomen. Information travels through this nerve to and from your central nervous system to control mood, sleep and other functions.

The idea behind vagus nerve stimulation is to stimulate the left vagus nerve in the neck with a series of electrical pulses traveling through a small surgically implanted wire attached to a pulse generator in the chest. The pulse generator, which is the size of a stopwatch, delivers stimulation to the vagus nerve in individualized therapeutic doses. Precisely how stimulation of the vagus nerve may improve depression remains unknown. Research indicates that vagus nerve stimulation alters the functioning of brain areas involved in mood regulation and depression.

The pulse generator is programmed to deliver electrical impulses to the nerve at various durations, frequencies and currents depending on the needs of the patient. Stimulation typically lasts for 30 seconds and occurs every five minutes. And doesn't typically causer any sensations in your body. The device is meant to be a permanent implant and is battery powered.

Now, why have you as a depressed person, not heard of VNS? First of all its approval for use on chronically depressed persons occurred only in 2005 and it typically takes new health technologies ten years before they are considered mainstream. But VNS has been around for a while because it has been used to help epilepsy patients since 1997. The first human clinical trial was in 1988, and the FDA approved VNS therapy for epilepsy in 1997. So far over 22,000 people worldwide have had VNS therapy, and it has proven to be a safe and effective treatment for epilepsy.

So what does this all have to do with chronic depression? When Vagus Nerve Stimulation was first approved for epilepsy, some patients reported an improvement in mood. Researchers decided to design a study specifically to measure changes in a patient's mood and depression due to stimulation of the vagus nerve. In 1999, scientists began the first study for depression with 60 patients and found that there was indeed an improvement in mood for depressed patients. Based on this study, a more detailed and thorough study was designed to determine if Vagus Nerve Stimulation would be a safe, tolerable and effective treatment for chronic depression.

The recently completed one-year, double blind, placebo controlled showed clinically significant improvements due to treatment compared to the baseline. Additionally, Vagus Nerve Stimulation therapy was approved for use in patients with treatment resistant depression in the European Union in March 2001, and in Canada in April 2001

In order for a person to receive Vagus Nerve Stimulation, surgery is involved. The Pulse Generator is implanted under the skin in the left side of the chest through a small incision. While this may sound like a serious or dangerous procedure, it is not. Most of these procedures are performed on an outpatient basis and the FDA has confirmed the safety of this procedure.

After surgery, Vagus Nerve Stimulation patients go home the same day or the next day. The patient may feel some minor stiffness/soreness around the area of the implant for a few days. The doctor may prescribe a minor pain medication such as Tylenol with codeine. A week later the surgeon will probably want to check the scars and a nurse can program/change the settings on the stimulator in the doctor's office.

The Vagus Nerve Stimulator can be turned off or removed at any time if the patient feels that it is not helping, or in the unlikely event that the patient can't tolerate the stimulation. The device can be completely turned off in less than 30 seconds in the doctor's office. Removal of the Vagus Nerve Stimulation device is also possible, however, less than one half of one percent of the 22,000 patients have elected to have the device removed.

Of course, Vagus nerve stimulation may not be appropriate for all cases of depression. In fact, the FDA approved use of vagus nerve stimulation in depression only for these specific situations: For treatment of long-term, chronic depression that lasts two or more years, in conjunction with standard treatments, recurrent or severe depression and depression that hasn't improved after the use of at least four other treatments, such as four different antidepressants.

Like any medical procedure Vagus nerve stimulation may cause side effects such as: Voice changes, hoarseness, cough, neck pain, breathing problems, difficulty swallowing, tingling or prickling of the skin and sore throat.

One big plus for anyone who has taken antidepressant medications is that vagus nerve stimulation doesn't have the side effects that are typical of antidepressants. For example: weight gain, sexual problems, memory problems, food or medication interactions, or sleep disturbances.

Interest in stimulating the brain to treat depression has grown in recent years. Researchers believe that changing the function of the brain in areas that control mood may help relieve symptoms of depression. So if the standard treatments just are not working and your depression is severe and long lasting, vagus nerve stimulation may be an option to discuss with your doctor.