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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Louisa on December 15, 1999, at 17:47:22
Found this in the AP 12/15/99
Filed at 5:06 p.m. EST
By The Associated Press
WASHINGTON (AP) -- The first small study where doctors implanted a pacemaker-like
device in the brain helped lift the moods of about 40 percent of severely depressed patients,
doctors reported Wednesday.The 30-patient pilot study does not prove this unusual brain-stimulating treatment really helps
depression, researchers cautioned.But sufferers of severe depression have clamored to try the experimental treatment since The
Associated Press disclosed the preliminary research in October. The pacemaker's
manufacturer, Cyberonics Inc., received several hundred phone calls from patients.Researchers reported Wednesday on an Internet version of the medical journal Biological
Psychiatry that this ``vagus nerve stimulation'' seemed to help 40 percent of study
participants.Joyce Daniels of Charleston, S.C., suffered severe depression for the past five years.
Medications and even electric shock therapy failed.``Sometimes I'd cry for a week. ... I got to a place where I'd just sit on the end of the couch all
day long,'' she said.She had the experimental brain stimulator implanted in March, and says she gradually began
improving.``It's not like you put it in and wake up the next day and feel the whole world's changed,''
Daniels said. But around October, she says she felt largely recovered.``The last five years I was walking through this fog, where there's nothing really clear to me in
my mind, and all of a sudden I got up one morning -- my mind has cleared up.''The stimulator is essentially a brain pacemaker.
A generator the size of a pocket watch is implanted into the chest. Wires snake up the neck to
the vagus nerve, which runs from the neck into a brain region thought important for regulating
mood. Every few minutes, the stimulating sends tiny electric shocks to that nerve and thus on
to the brain.The stimulator already is sold as a treatment for epilepsy.
For depression, it is ``extremely encouraging as a potential treatment,'' but more study is
needed to prove the effect, said the lead investigator, Dr. John Rush of the University of
Texas Southwestern Medical Center.Several study participants took antidepressants along with the brain stimulator, and it is
possible the implant somehow helps medicine work better, said co-researcher Dr. Lauren
Marangell of the Baylor College of Medicine.A 200-patient study scheduled to begin next summer will offer a better test. Doctors are
debating implanting all the patients with a stimulator, but not immediately turning on all the
implants, hoping to prove any relief is not just a placebo effect.During the 30-second zaps, the implant can cause temporary hoarseness in about 30 percent
to 40 percent of patients. Rush said few were bothered by the little voice breaks, but said one
patient who sang in her church choir did turn off the stimulator while singing.------
For information on enrolling in next summer's study, call Cyberonics at 1-800-332-1375, ext.
690.
Posted by John B on December 16, 1999, at 2:38:23
In reply to New Study -- anyone know anything more?, posted by Louisa on December 15, 1999, at 17:47:22
Sounds interesting.. kinda wonder if that wire goin up your neck might tickle a bit.
I hear'd of a study where they were using magnets . . . with some promising results apparently . . . hey, who knows?
Hey, I wonder if I pointed the TV remote at my head and hit the power button real fast:) . . . hmmmm . . .
Posted by Noa on December 16, 1999, at 11:58:08
In reply to Re: New Study -- anyone know anything more?, posted by John B on December 16, 1999, at 2:38:23
There was a previous thread about this new device. Apparently while studying it for epilepsy, the researchers heard from subjects that their depression had lifted. It is heartening to see new and varied approaches, as many of us know how frustrating it can be to try med after med.
On a lighter note, it reminds me of the movie Sleeper and the orgasmatron, and wonder what it would be like if the device went off too frequently--too many happy shocks?
Posted by dj on December 17, 1999, at 2:05:38
In reply to New Study -- anyone know anything more?, posted by Louisa on December 15, 1999, at 17:47:22
> During the 30-second zaps, the implant can cause temporary hoarseness in > about 30 percent to 40 percent of patients.I posted a few comments and clippings in an earlier thread, a couple of months ago on the Vagus nerve stimulator after Janice brought it to everyone's attention. The co. has a website whtere there are discussion threads on the effect on patients, which is referenced in one of those earlier threads..
Just reading this piece above, now the bit on hoarsness struck me. For me stress, anxiety and depression are all very much a mix. AND one of the strongest indicators of high stress for me is incredible upper body tension, particularly in the shoulders and neck area. When I am very stressed I start to gag and choke, as if someone has a hand around my throat and sometimes get the dry heaves. As well, when I'm stressed but not to that degree I will get sore throats that feel like I'm swallowing glass. As well my vocal cords get very tight and my voice lowers considerably to the degree that more astufe folks have remarked on it. In public speaking situations I can go very, noticiably rigid, when feeling the stress...
I'm curious if others have experienced some of the same symptoms and if so what have you done to counteract them, beyond f***ng psycho-chemical solutions, which are TOO much the focus on this board, too often. Chemicals are not the only solution, though you would think they are from this board. They can be helpful but are not sufficient, as with most treatments...for most maladies...
Posted by Noa on December 17, 1999, at 6:51:05
In reply to Re: New Study -- Hoarseness effect, hmmm???, posted by dj on December 17, 1999, at 2:05:38
Hey, DJ, haven't seen you in a while. Good to see you again.
I think one of the reasons the focus of this board is weighted toward psychopharm is that it is an adjuct to the psychopharmocology tips site. But I don't think it has to be limited to pharm. In fact, very often, my posts are more about the experience of living with depression. I think there is room for both.
That being said, let me address your specific topic. I have found myself becoming increasingly sensitive to having anything touching my neck, the front part, oftencalled the throat. Today I am wearing a turtle-neck shirt and I am constantly pulling at the neck because it is bugging me, causing anxiety and feelings of being strangled. I don't know if the increased sensitivity is due to my depression, or due to my sleep apnea, which caused me to literally choke in my sleep (under control now with cpap), or due to the huge amount of weight I have gained in past couple of years that has made me practically "lose" my neck to my chins. Perhaps it is a combination.
When I have performance anxiety, like having to speak in public, my voice has a mind of its own. It starts to shake rattle and roll, and then when I notice this happening, I feel more anxious and the voice problems worsen.
My voice definitely sounds different depending on my mood. Sometimes in a therapy session, it varies depending on what I talk about. It is not consciously done, but I am becoming more conscious of it.
Posted by juniper on December 17, 1999, at 22:56:44
In reply to Re: New Study -- Hoarseness effect, hmmm???, posted by Noa on December 17, 1999, at 6:51:05
while i wish i had information on the hows or whys of such a choking feeling--it does sound to me similar to symptoms in a mild panic attack, i can only relay a time that i still see as particularly odd. i was depressed, and became uncontrollably upset over a movie (of course this was just the catalyst) (Babe, of all the things...the duck looking in the window as his friend is being eaten...). i began having what i now know was a panic attack, with the salient symptom being that i could not speak. i could hardly breath. i felt the words and the letters, viseral, in my throat, but was unable to relay them. i felt as if i were to throw up, and was certain that if i spoke somehow the words themselves would trigger this.
i'd love to know the physiological mechanisms that contribute to such things. i assume that it has something to do with the CNS feeling that it is under attack and retaliating (closing the airway to keep germs out?), but if anyone has more specific information, i'd be interested.
juniper
Posted by Noa on December 17, 1999, at 23:33:13
In reply to Re: New Study -- Hoarseness effect, hmmm???, posted by juniper on December 17, 1999, at 22:56:44
I think it might be helpful to read "Why Zebras Don't Get Ulcers" by Robert (?) Sapolsky. It is about the physiology of stress. I read it a while ago so I don't remember if these panic symptoms are covered much, but the general physiology of the flight or fight response is explained well.
Posted by Zeke on December 18, 1999, at 13:06:40
In reply to Re: New Study -- Hoarseness effect, hmmm???, posted by juniper on December 17, 1999, at 22:56:44
> while i wish i had information
>
> i'd love to know the physiological mechanisms that contribute to such things.Emotion, Memory and the Brain
http://users.erols.com/toddstar/LeDoux1.htm
I wonder how much we know of the real events causing our individual anxiety reactions. I think having some explanation is more important than having the correct explanation (I'm speaking of persons here, not neuroscience). But even correctly knowing the outside cause isn't enough: As LeDoux says, we will jump at the sight of a springing snake, even though it is enclosed behind glass. Fear (emotion) pathways act before the cortex can, and emotional responses are less easily stopped than started. And moreso when prefrontal areas are dysfunctional. Isn't this the area that psych meds act???Please see the LeDoux URLs below...
LeDoux outlines his theory of emotions and memory
http://www.apa.org/monitor/oct97/ledoux.htmlFear Itself: What we now know about how it works, how it can be treated, and what it tells us about our consciousness.
http://www.psych.nyu.edu/dept/news/nytimes0299.htmlThe LeDoux Lab, Center for Neural Science, New York University
http://www.unomaha.edu/~spaige/ledouxindex2.htmlEmotion, Memory and the Brain
http://users.erols.com/toddstar/LeDoux1.htm
Posted by Zeke on December 18, 1999, at 13:12:43
In reply to New Study -- anyone know anything more?, posted by Louisa on December 15, 1999, at 17:47:22
Vagus nerve stimulator successful for depression
Contact: Ann Harrell
(214)648-3404
or e-mail: ann.harrell@email.swmed.eduDALLAS - December 15, 1999 - A nationwide clinical trial has shown Vagus Nerve Stimulation (VNS), an
electrical stimulation therapy currently used to combat epilepsy, to be a promising new method for treating
patients with severe treatment-resistant depression.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.Besides Rush, UT Southwestern researchers included Dr. Mustafa Husain, associate professor of psychiatry;
nurse Diane Stegman in psychiatry; and Dr. Cole Giller, associate professor of neurological surgery. Other
authors included Dr. Harold Sackeim at Columbia; Dr. Mark George at the Medical University of South Carolina;
and Dr. Lauren Marangell at Baylor.
Posted by dj on December 19, 1999, at 23:29:17
In reply to Vagus again..., posted by Zeke on December 18, 1999, at 13:12:43
This from the Cyberonics site, I haven't checked it out myself:
Cyberonics conference call has some very interesting information presented by Dr Rush, Univ. of Texas, pertaining to VNS initial 30 subject study on depression.
Dial 1-(800)633-8284, then enter 13818182#, then enter #
You must call on or before 12/21 when taping of call will be removed.
Posted by dj on December 19, 1999, at 23:37:21
In reply to JUNIPER: Want to know, try LeDoux, posted by Zeke on December 18, 1999, at 13:06:40
> > while i wish i had information
This stuff looks interesting. I don't have the time to check it out right now, however if any of you would like to summarize or cut & paste some content here that would be cool!Definitely there are some strange unconscious bio-chemical reactions that lead to this degree of sensitivity. Like Noa I too have problems with turtlenecks and definitely with neckties, which I always wear loose and even then the GAG.. reflex kicks in, on too many occasions...
Definitely linked to stress, perhaps mild panic and perhaps to my very early days wearing a little tie and blazer to church which I hated...though the gag reflex really kicked in strongly about 14 years ago and was linked to a very stressful work situation, such that as I approached my place of work it would kick in... Usually it happens when no-one else is around though that has been less the case this past year...it'd damm annoying, freaky and frightening on various levels and is part of the reason I am interested in approachs beyond meds, which help some but are not sufficient and often have negative side effects as bad or worst than those they are supposed to relieve.
Nice to hear from you too, Noa. Bob's been unusually quiet for the past few days and Janice has come and gone again...go figure...
Ciao!
> >
> > i'd love to know the physiological mechanisms that contribute to such things.
>
> Emotion, Memory and the Brain
> http://users.erols.com/toddstar/LeDoux1.htm
> I wonder how much we know of the real events causing our individual anxiety reactions. I think having some explanation is more important than having the correct explanation
Posted by juniper on December 22, 1999, at 23:46:45
In reply to JUNIPER: Want to know, try LeDoux, posted by Zeke on December 18, 1999, at 13:06:40
thank-you for your helpful links, i'm always wondering about the interplay of the physical and emotional, if such things can be separated.
This is the end of the thread.
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