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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Diane E. on August 29, 2000, at 16:42:43
Does anyone have any personal experience with VNS? I have read the recent Biological Psychiatry article on the
pilot study (available at: http://www.bcm.tmc.edu/psych/mdoc/research/vnsdo1.pdf ) and it sounds somewhat
promising for treatment resistant depression. I'm curious what others here think. I realize that a thread on this
topic disintegrated into a lot of less than civil postings a couple of months ago. I'm not sure why that was.Thanks for any input.
-Diane
Posted by shellie on August 30, 2000, at 10:19:24
In reply to Vagus Nerve Stimulation (VNS), posted by Diane E. on August 29, 2000, at 16:42:43
Hi Diane. Thanks for providing the study. My thoughts on reading it is that a 40% success rate with possible voice disruption during stimulation is not too impressive. I think I'd probably try every combination of drugs there are instead. It's surgury--so if it doesn't work you've put your body through a lot for nothing. I'd wait until the percentages get up into the 70s. I guess if you've tried everything (I did find it interesting that subjects who had failed with ect also failed with VNS), maybe its an option. Shellie
Posted by SLS on August 31, 2000, at 12:42:29
In reply to Re: Vagus Nerve Stimulation (VNS) » Diane E., posted by shellie on August 30, 2000, at 10:19:24
> Hi Diane. Thanks for providing the study. My thoughts on reading it is that a 40% success rate with possible voice disruption during stimulation is not too impressive. I think I'd probably try every combination of drugs there are instead. It's surgury--so if it doesn't work you've put your body through a lot for nothing. I'd wait until the percentages get up into the 70s. I guess if you've tried everything (I did find it interesting that subjects who had failed with ect also failed with VNS), maybe its an option. Shellie
The 40% statistic should be evaluated within the context of the population of subjects who participated in the studies. Most of them were resistant to pharmacotherapy. That 40% of treatment-resistant patients respond to VNS is very high and might make it a justifiable alternative. I guess I'll have to put it on my list. I really don't want to.Real expensive - $20,000 or so. I don't think many (if any) insurance companies would pay for it since it is not approved for the treatment of depression. Now would be a good time to get in on a free study.
- Scott
Posted by Diane E. on August 31, 2000, at 13:16:07
In reply to Re: Vagus Nerve Stimulation (VNS), posted by SLS on August 31, 2000, at 12:42:29
> The 40% statistic should be evaluated within the context of the population of subjects who participated in the studies. Most of them were resistant to pharmacotherapy. That 40% of treatment-resistant patients respond to VNS is very high and might make it a justifiable alternative. I guess I'll have to put it on my list. I really don't want to.
> Real expensive - $20,000 or so. I don't think many (if any) insurance companies would pay for it since it is not approved for the treatment of depression. Now would be a good time to get in on a free study.
>
> - ScottScott,
I tend to agree that 40% is high given the high level of treatment resistance in the study members.I do not beleive you can get VNS for depression right now unless you participate in the next study. It has not
been FDA approved for depression and apparently the company will not provide the units to doctors for
off-label use. My husband is currently being evaluated for participation in the study. It will be
taking place at 15-20 sites throughout the country. We don't yet know if he will be allowed to
participate and he hasn't decided if he is willing to participate if he is accepted.Personally, I don't know what to think about it. It is hard to get our hopes up again, but on the other hand,
no one seems to have a more promising solution. ECT is about the only remaining suggestion
he has received (aside from VNS).What else is on your list of possible options?
-Diane
Posted by SLS on September 1, 2000, at 9:11:45
In reply to Re: Vagus Nerve Stimulation (VNS), posted by Diane E. on August 31, 2000, at 13:16:07
Hi Diane.
I don't feel inclined to try VNS at this time. It is a difficult decision to make.
I just began taking a combination of Parnate + desipramine. My condition had deteriorated to a dangerous point, and I decided that it made sense to get some relief as soon as possible. Over the last ten years, this combination has produced only a mild improvement for me. However, in 1987, it produced the only sustained robust remission from depression I have ever experienced. Unfortunately, my doctor at the time decided to discontinue the combined treatment because I began to experience mania. When I relapsed fully into depression two months later, he wanted to try Prozac, which had then just been approved. A new toy. No luck. He should have immediately restarted me on what had worked the first time, given my history of treatment-resistance. For me, severe depression began in 1977 (age 17). His decision has cost me more than words can describe.
If you folks haven't explored MAO inhibitors in combination with other drugs, I think it makes sense to head in that direction should you choose not to go for the VNS.
1. Lithium
2. Tricyclics
3. Stimulants
- Adderal
- Dexedrine
- Ritalin
4. Dopamine agonists
- Mirapex
- Pergolide
- Parlodel
5. Lamictal
6. Other mood stabilizers
I am to see a new doctor in two weeks. I tried very hard to remain "clean" and give him a clean slate to work with. Hopefully, he will have some new ideas on how to augment Parnate. If he decides to have me discontinue it should it prove inadequate, at least my system will be in a better state to handle another period of ineffective treatments.Combining Effexor with Remeron is emerging as being a particularly effective treatment in difficult cases.
Good luck.
- Scott
Posted by Diane E. on September 1, 2000, at 12:25:33
In reply to Re: Vagus Nerve Stimulation (VNS) » Diane E., posted by SLS on September 1, 2000, at 9:11:45
Scott,
Thanks for sharing your experiencs and thinking. What does it mean to remain "clean." Have you
stopped the Parnate and desipramine? You said your depression became dangerous. Is that still
true? I hope you are experiencing some relief from your current strategy.My husband currently takes Parnate, neurontin, clonapin and respiradol. He has been on this combo.
about 12 weeks and it has no effect that I can see. He has tried most of the other meds. you listed,
though not all of them and not all of them in combination with an MAOI. I don't believe he has tried any
dopamine agonists; at least he has not been on any of the ones you listed (are there others?). The
startling thing to me about his medication history is that none of these meds. have any effects or side-effects
for him. He has never experienced a decrease in his depression on any meds. (7+ years of trying),
and the only side-effects are some trouble with urination and dry-mouth for a few days after he starts a
new med. Also, he experiences no withdrawal when he stops a med, including clonapin. His pdoc
recently upped his dose to 6 Parnate tablets a day (sorry, I'm not sure of the dose/tablet). He was
previously taking 5 tablets all at once. His pdoc was stunned that he didn't feel dopey after such a large dose
all at once, but he says he feels nothing. I guess this is why we are skeptical about any other meds.
working. It seems like maybe he metabolizes them so fast or throughly that they don't have any effect.
Is that possible?-Diane
Posted by Ant-Rock on September 1, 2000, at 19:04:45
In reply to Re: Vagus Nerve Stimulation (VNS) » Diane E., posted by SLS on September 1, 2000, at 9:11:45
Hi Scott,
Sorry to hear about your recent struggles. I certainly can relate. I hope you feel better soon. It seems like more and more of the long time contributors here are finally doing much better, and my guess is that you are probably next. Keep the faith.
Sincerely,
Anthony
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