Device offers new hope for depression
Web Posted:
06/20/2006 12:00 AM CDT
She has been misdiagnosed,
overmedicated, inaccurately medicated and suicidal, somehow surviving
long years of despair when she slept most of the day and spent every
waking moment thinking about how to end her life. "I found Web sites that actually tell you how to die," recalls Lauri
Ticas. "I would spend hours and hours researching how I could die. I
was obsessed." Diagnosed with bipolar disorder (manic
depression), Ticas, an attractive, articulate 35-year-old, has suffered
mainly from depression with almost no manic episodes for more than 20
years of illness. As happens in some bipolar cases, an antidepressant
sent her into a psychotic, hallucinatory state about six years ago. She
was misdiagnosed with schizophrenia, hospitalized and treated with
powerful antipsychotic drugs. She finally found a doctor who recognized
the error and weaned her off the medication. About 19
million Americans have depression, according to the National Mental
Health Association, and more than 2 million struggle with bipolar
disorder. Experts say that, like Ticas, a small percentage of people
with these illnesses find medications simply don't work. They are
treatment-resistant. Actually, electroshock therapy,
known as ECT, did alleviate Ticas' deep depression for a while. In
2004, she began treatments under anesthesia every month, but after more
than a year, she started having serious ECT-related memory loss. Then
the headaches hit. "These were headaches where I was just doubled over
in the fetal position, and even taking prescribed medication, nothing
would touch the pain." She had to stop ECT. Desperate, Ticas scoured the Internet looking for alternative
treatments or even supplements or herbs that might help. She spotted
something about approval of the vagus nerve stimulator for depression
and in January began treatment that has turned her life around.
"Depression used to control me," she observes one morning, seated at
the kitchen table in her Northeast Side home. "Now I control the
depression." The vagus nerve stimulator has been around
for a while, approved for the past eight years for the treatment of
epilepsy. In 2005, after the required clinical trials, the Food and
Drug Administration approved its use for chronic or recurrent
treatment-resistant depression and bipolar disorder. Under anesthesia during a one- to two-hour outpatient surgery, a
small
incision was made on the left side of Ticas' chest and the
pocket-watch-sized, battery-powered generator implanted under the skin.
Through a second small incision tucked into a crease in her neck, a
wire leading up from the generator under the skin was wrapped around
the left vagus nerve, the nerve whose pathways connect the brain with
the major organs. She went in for the surgery early one morning and
left for home by noon. The VNS generator is programmed to
activate every five minutes for about 30 seconds, and the intensity and
duration of the mild electrical stimulation can be adjusted. Aneta
Schuenemeyer, the psychiatrist who is treating and monitoring Ticas,
says her device is not yet set at full power, but she is doing very
well and not on any medication, even though VNS therapy is designed as
long-term adjunctive therapy to be used with drugs. In
addition to helping people for whom antidepressants don't work, VNS is
an option for patients who can't take any of the psychiatric
medications because of bad side effects. "It's about to
go off again," Ticas says as her voice gets low and hoarse, the only
outward sign that VNS therapy is at work. The main side effects during
stimulation are sore throat, hoarseness, coughing or shortness of
breath. She doesn't even notice the electrical stimulation any more but
recalls that after one boost in intensity, she felt like she had
something stuck in her throat. She has some external
control of the pacemaker-like generator. If she's on the phone or needs
to speak for any length of time, she can place a small magnet over the
device to stop activation. When she removes the magnet, the generator
activates normally. Sarah Bennington, an assistant
professor of psychiatry at the University of Texas Health Science
Center who is conducting a study of VNS therapy, says the most common
cardiac effect of VNS therapy is a lowered heart rate, although one of
her patients had an increased heart rate. It is not entirely clear how
the device works on depression although it's thought it affects
neurotransmitters and brain activity involved in mood. "The vagus nerve is one of the cranial nerves and it has a lot of
functions. It mediates messages from different body organs to the
brain. One theory is (VNS) helps to generate proteins in the areas of
the brain that are involved in depression," Bennington says. According to Cyberonics, the company that makes the vagus nerve
stimulator, more than 5,000 psychiatrists have been trained in the
device at company-sponsored education programs and some 1,100 patients
have been treated with VNS therapy for depression. Ticas was covered
under Medicare, but coverage varies by insurance providers. The device
itself costs $15,000 and with implantation, total cost is about
$25,000. Cyberonics cites data indicating that VNS
therapy is safe and effective, with more than 50 percent of patients
experiencing clinical benefit and with antidepressant benefits
sustained over time. The company Web site (www.cyberonics.com) has
information about the device. Ticas says her depression
and mood improved two months after VNS implantation, although it may
take longer for some patients to see benefit. "My anxiety level has
decreased. My impulsiveness has lessened. Now, I think before I react.
I still have days when I'm down, but the difference is now, I can do
something to change the way I'm feeling. I can go see a friend, take a
walk, do something. Before, that wouldn't work." She
credits the support and understanding of husband Julio and son Roy, 15,
in her recovery. Right now, she isn't working, but her days are filled
with family, home, friends, church activities and her great joy —
cooking. "Look," she says pulling down a tattered cookbook from atop
the refrigerator. It's filled with recipes from Los Barrios Mexican
Restaurant. "You can tell, I've used this so much. I love to cook,
mostly Mexican and Tex-Mex." Looking back, she wistfully
remembers the girl who was a high achiever, academically and
athletically, the young woman who started college but never finished
because of recurring, crushing depression. VNS therapy has opened up a
world of possibilities she thought were lost forever. "I
was telling Dr. Schuenemeyer, if I didn't have this health condition
all these years, I had a lot of potential. I think I still do. I might
go back to college. I feel like I have another opportunity — a second
chance at life." Her voice goes hoarse as she speaks. The stimulator is activating
again.
mpisano@express-news.net