Device Offers Depression Victim Hope After Years of Misdiagnosis
June 21, 2006
SAN ANTONIO (The New York Times News Service) -- 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.
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. "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 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 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 San Antonio's 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.
Copyright 2006 The New York Times News Service. All rights reserved.