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Since the subject of depression was broached yesterday I thought I'd share this article that I ran across today. It is a long read but hopefully informative. Enjoy.
Implant can relieve depression
VNS therapy is proving beneficial
By Leslie Goldman
Special to the Tribune
May 1, 2007
If April showers bring May flowers, what do May flowers bring?
Sadly, the answer for many people is depression. So many, in fact, that for more than 50 years the National Mental Health Association has named May National Mental Health Awareness Month to debunk the myth that depression affects more people during the winter. Suicide rates actually skyrocket in May, with more occurring during that month than any other.
The reason is unknown, though some experts believe it has to do with people who have bipolar disorder experiencing mood shifts with the longer days, while others think that as Seasonal Affective Disorder patients experience a reprieve from symptoms, other patients feel a sense of isolation or being "left behind" because their depression lingers, intensifying symptoms.
Medications don't help
Despite the fact that depression affects more than 18 million Americans and 300 million people worldwide each year, the disease often goes untreated. And even when help is sought, some cases may be resistant to therapy. Results from the largest government-funded study on depression, STAR*D, show that a third of patients prescribed at least four antidepressant treatments do not experience any remission from depression, meaning they are "treatment-resistant."
One of those was Susan Cooperman, 48, of Lake Villa. Cooperman remembers suffering from sadness, even as a little girl, with a sense of hopelessness festering through her teens. She tried alcohol and drugs as a way to self-medicate, which only led to more misery, so in her middle-20s, Cooperman began seeing a psychiatrist. She estimates she tried 50 medications over about 25 years but to no avail.
"I would still get depressed -- crying, hiding, not answering the phone," she said. "I wouldn't go into work." (She worked as a delivery driver for her family's business.)
In 1999, at age 41, her doctor suggested electroconvulsive therapy treatments. The treatment worked for about a month at a time. "It was great, but it wore off."
That's when her psychiatrist learned about a Chicago-area study for a promising new treatment option, vagus nerve stimulation. VNS therapy involves implanting a small, pacemakerlike device, about the size of a silver dollar, beneath the muscles in the chest wall through a small incision under the collarbone. A second incision is made on the left side of the neck, near the vagus nerve, which projects up to the brain. Coils are wound around the vagus nerve, and thin wires connect it to the generator in the chest. An external device is then used to send mild, intermittent pulses to the brain via the nerve; the theory is that these impulses can affect certain brain neurotransmitters, such as serotonin, dopamine and norepinephrine, reining in depression, explained Dr. John Zajecka, medical director of the Woman's Board Depression Treatment and Research Center at Rush University and a Rush North Shore Hospital psychiatrist specializing in treatment-resistant depression.
A safe procedure
"I was surprised to see how innocuous the implant is," Zajecka said of VNS, which is done on an outpatient basis (the patient takes two weeks to heal, then returns to have the device activated.) Not only is it safe, recently approved by the Food and Drug Administration in 2005 for treatment-resistant depression, it appears to be highly effective. "The data is very consistent that when it starts to work; the effect is persistent," Zajecka said, adding that while some individuals show a response early on, it typically takes about three months to experience a real difference and a year for complete remission.
For Cooperman, who received her VNS implant in 2005 and felt an improvement in her mood within a month, the therapy has "been a miracle."
"It's like I came out of my shell," said Cooperman, who has lowered the doses on her antidepressants and is back to work at her family's business. She also plans to begin volunteering at a local nursing home.
Zajecka (who did not treat Cooperman) said that, considering the physical and emotional toll depression takes on the individual as well as society, it's important to keep offering new and alternative treatments to patients. He recently attended a meeting on treatment-resistant depression and "was amazed at how many people have [committed suicide] waiting for insurance approval for VNS. Medicare has not approved it yet. It's on a case-by-case basis. There were physicians in tears at this meeting talking about waiting for approvals. How many people are being turned down for a potentially effective treatment?"
'Hope out there'
Cooperman said she lost count of the number of phone calls and letters she, her doctors and nurses made in an attempt to get her enrolled in a government-funded VNS study. Once the FDA approved the therapy, her insurance company paid nearly the entire amount.
Her message for other people suffering from this debilitating, though treatable disease: "There is hope out there. I still see my psychiatrist for my medications, see my therapist and take my meds -- those are the three most important things." Also, if she feels the shadow of depression creeping back up on her, Cooperman can rub a special device over her VNS implant to increase the stimulation and she begins to feel an improvement in her mood within 10 minutes. But for Cooperman and those around her, the proof that she is healthier is evident in seemingly simple, everyday occurrences, versus the incredibly complex medical performance taking place inside her body.
"Before, we'd have family parties, and I'd just wander around the house," she recalled. But when her sister recently celebrated her 50th birthday, "I was on the dance floor, making a fool of myself, and I didn't care."
-------------------------------------------------------------
[email protected]
Copyright © 2007, Chicago Tribune
Implant can relieve depression
VNS therapy is proving beneficial
By Leslie Goldman
Special to the Tribune
May 1, 2007
If April showers bring May flowers, what do May flowers bring?
Sadly, the answer for many people is depression. So many, in fact, that for more than 50 years the National Mental Health Association has named May National Mental Health Awareness Month to debunk the myth that depression affects more people during the winter. Suicide rates actually skyrocket in May, with more occurring during that month than any other.
The reason is unknown, though some experts believe it has to do with people who have bipolar disorder experiencing mood shifts with the longer days, while others think that as Seasonal Affective Disorder patients experience a reprieve from symptoms, other patients feel a sense of isolation or being "left behind" because their depression lingers, intensifying symptoms.
Medications don't help
Despite the fact that depression affects more than 18 million Americans and 300 million people worldwide each year, the disease often goes untreated. And even when help is sought, some cases may be resistant to therapy. Results from the largest government-funded study on depression, STAR*D, show that a third of patients prescribed at least four antidepressant treatments do not experience any remission from depression, meaning they are "treatment-resistant."
One of those was Susan Cooperman, 48, of Lake Villa. Cooperman remembers suffering from sadness, even as a little girl, with a sense of hopelessness festering through her teens. She tried alcohol and drugs as a way to self-medicate, which only led to more misery, so in her middle-20s, Cooperman began seeing a psychiatrist. She estimates she tried 50 medications over about 25 years but to no avail.
"I would still get depressed -- crying, hiding, not answering the phone," she said. "I wouldn't go into work." (She worked as a delivery driver for her family's business.)
In 1999, at age 41, her doctor suggested electroconvulsive therapy treatments. The treatment worked for about a month at a time. "It was great, but it wore off."
That's when her psychiatrist learned about a Chicago-area study for a promising new treatment option, vagus nerve stimulation. VNS therapy involves implanting a small, pacemakerlike device, about the size of a silver dollar, beneath the muscles in the chest wall through a small incision under the collarbone. A second incision is made on the left side of the neck, near the vagus nerve, which projects up to the brain. Coils are wound around the vagus nerve, and thin wires connect it to the generator in the chest. An external device is then used to send mild, intermittent pulses to the brain via the nerve; the theory is that these impulses can affect certain brain neurotransmitters, such as serotonin, dopamine and norepinephrine, reining in depression, explained Dr. John Zajecka, medical director of the Woman's Board Depression Treatment and Research Center at Rush University and a Rush North Shore Hospital psychiatrist specializing in treatment-resistant depression.
A safe procedure
"I was surprised to see how innocuous the implant is," Zajecka said of VNS, which is done on an outpatient basis (the patient takes two weeks to heal, then returns to have the device activated.) Not only is it safe, recently approved by the Food and Drug Administration in 2005 for treatment-resistant depression, it appears to be highly effective. "The data is very consistent that when it starts to work; the effect is persistent," Zajecka said, adding that while some individuals show a response early on, it typically takes about three months to experience a real difference and a year for complete remission.
For Cooperman, who received her VNS implant in 2005 and felt an improvement in her mood within a month, the therapy has "been a miracle."
"It's like I came out of my shell," said Cooperman, who has lowered the doses on her antidepressants and is back to work at her family's business. She also plans to begin volunteering at a local nursing home.
Zajecka (who did not treat Cooperman) said that, considering the physical and emotional toll depression takes on the individual as well as society, it's important to keep offering new and alternative treatments to patients. He recently attended a meeting on treatment-resistant depression and "was amazed at how many people have [committed suicide] waiting for insurance approval for VNS. Medicare has not approved it yet. It's on a case-by-case basis. There were physicians in tears at this meeting talking about waiting for approvals. How many people are being turned down for a potentially effective treatment?"
'Hope out there'
Cooperman said she lost count of the number of phone calls and letters she, her doctors and nurses made in an attempt to get her enrolled in a government-funded VNS study. Once the FDA approved the therapy, her insurance company paid nearly the entire amount.
Her message for other people suffering from this debilitating, though treatable disease: "There is hope out there. I still see my psychiatrist for my medications, see my therapist and take my meds -- those are the three most important things." Also, if she feels the shadow of depression creeping back up on her, Cooperman can rub a special device over her VNS implant to increase the stimulation and she begins to feel an improvement in her mood within 10 minutes. But for Cooperman and those around her, the proof that she is healthier is evident in seemingly simple, everyday occurrences, versus the incredibly complex medical performance taking place inside her body.
"Before, we'd have family parties, and I'd just wander around the house," she recalled. But when her sister recently celebrated her 50th birthday, "I was on the dance floor, making a fool of myself, and I didn't care."
-------------------------------------------------------------
[email protected]
Copyright © 2007, Chicago Tribune
