Deep Brain Stimulation (DBS)

It kind of bothers me that psychology books and websites seem to publish more information on rTMS (transcranial magnetic stimulation) and DBS (deep brain stimulation) than they do about VNS.  VNS is the only one of those treatments that’s been FDA approved — so why aren’t people talking about it more?

I’ve been watching the research on DBS with a lot of interest.  It seemed to me that if stimulating a nerve that went up into the brain (as VNS does) was helpful, then directly stimulating the brain would totally be the bomb!  But I read an article in the American Psychological Association’s magazine, The Monitor, and I feel a little less enthusiastic. 

I thought there had been a lot more research done with DBS — right now a mere 60 people have been treated with it for psychological problems like depression and OCD.  Sixty?!  That’s a ridiculously low number for them to be touting it as the Next Big Thing.

Plus I don’t like the fact that some people seem to have cognitive impairments afterwards.  You can have thinking and memory problems following ECT (electroconvulsive therapy) without having someone drill holes in your skull!  (Is this the acronym post or what? *wink*)

To be useful, these approaches really have to be better than existing approaches.  The problem with rTMS is that the effects don’t last long.  I also don’t get the impression that they’re as powerful as they are with ECT. 

The problem with DBS is they have to drill a hole in your skull in addition to implanting a pacemaker-like device in your chest and running wires up your neck (like they do with VNS).  I don’t want anybody poking around in my brain unless they’re damn sure they know what they’re doing — and that it’s going to work!

I do think it’s an exciting time in psychology.  I keep wondering if eventually some people will be able to move away from medications altogether and we’ll be able to repair malfunctioning parts of the brain with implants like these.  I’m still excited about my VNS, and I think it’s cool to be on the cutting edge of modern science.  I think it’s even more exciting that they’re just continuing to do research on VNS, and they’re learning more and more about ways to help people with depression with it.

I am extremely hopeful that I will see even more improvements over the next six to eight months with my VNS!

Relapse & Frustration

Well, I’ve fallen back into the hole.  Between some family upheaval and hormones, I went down and just can’t seem to pull myself back up.  I really, genuinely don’t think what I was getting before was a placebo effect, but I am frustrated by how down I am.

I went to see my psychiatrist, and she adjusted my meds, so now I am at 300mg Effexor, and we’re going to add 10mg of Prozac and remove the Lexapro.  Eventually we’ll go up to 20mg of Prozac.

I have noticed it is much harder to exercise since I got the implant.  I feel winded much more easily.  Not just when the stimulation is on, either; across the board.  That’s also frustrating.

Supposed to see the dr who manages the VNS next week (moved from this week due to conflicts on her end).  I definitely want to go up some more, and my psychiatrist agreed.  So hopefully 1.25 will help me feel better again…

VNS and Me

The first, and most obvious question, is — What is VNS?

VNS stands for Vagal Nerve Stimulation. The Vagus nerve runs down from the brain stem and affects all those important internal organs — heart, lungs, etc. According to Wikipedia, “Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and clinical depression. VNS uses a stimulator that sends electric impulses to the left vagus nerve in the neck via a lead implanted under the skin.”

So that brings us to this blog.

I’m getting the VNS implant in two days for chronic and recurrent depression, and I intend to chronicle my experience with it here.

But let me bring you up to speed with a little info on me. I’ve had problems with depression since I was 11. It was kind of like being the unwitting victim of a landslide. One minute I was struggling through adolescence like any other kid, the next I was buried under a few tons of sharp and painful rocks, wondering what the hell hit me.

In the 25 years since, I’ve taken every psychological test, done all kinds of therapy, and taken damn near every medication on the market.

The problem is, a med will work for a little while and then stop, leaving me back where I started. I seem to have that problem every year to two years. Right now I’m taking a cocktail of meds that makes even the pharmacists raise their eyebrows (and you know they see everything). We had to just keep adding things until I was functional again. I was in bad shape this time around…bad enough that I was ready to try anything. (It only occurs to me after I wrote that that “I was suicidal” might have more impact on the reader. I don’t even see “I was suicidal” as shocking anymore. Suicidal is a given when I get bad. I can’t stand to be conscious when I get bad, so I “self-medicate” with sleep, sleeping 16-20 hours a day, easily. Not so good for the career.)

Anyhow, here’s my cocktail.

Effexor — 225 mg
Abilify — 4 mg
Lexapro — 20 mg
Trazodone — 100 mg
Synthroid — 100 mcg
Cytomel — 25 mcg
Lamictal — 100 mg
Deplin — 7.5 mg

Those are just the drugs for the depression. And I’m still having trouble.

I’ve also taken

Prozac
Zoloft
Celexa
Wellbutrin
Cymbalta

and a handful of old-standby antidepressants called tricyclics and MAOIs.

I’m kind of nervous about having this thing implanted. I mean, in some ways it feels really counterintuitive to me. I want my depression taken out, so we’re putting something in? But I guess that’s how medication works, too. You put it in the body.

On the other hand, if it could mean never having to sleep just to stay alive again, freaking wire me up!

Oh, one more thing I should add in this first entry. Insurance has refused to pay for it. They don’t care that I’ve wrestled most of my life with this disease, this monster, this demon; their refusal letter is practically a rebuke. And they are cheerfully sure to add that they don’t care if you have a life-threatening illness for which this is the only treatment — they’re not paying, dammit. But hey, have a nice day.