Could ECT or Vagus nerve stimulation be the answer?

Question

I've had major depression for most of my life, I'm 32 years old. I tried pretty much all the meds available to no success. I'm tired of living this way. Does anybody have experience with ECT or Vagus nerve stimulation? Thanks

Answer 1

With regard to electroconvulsive therapy, this treatment is controversial, and just this month the person considered the leading expert and proponent of ECT (Harold Sackeim) admitted that ECT routinely causes potentially permanent amnesia and cognitive dysfunction (problems thinking), after preaching for 25 years that it did not, and the American Psychiatric Association adopted his position that it did not cause brain damage. This new study published this month was actually the FIRST large-scale study (believe it or not) to even check for peristent cognitive dysfunction after ECT. His results show, albeit indirectly, that ECT may cause brain damage that may be irreversible in some people. And his study only checked simple measures of cognitive function. It didn't delve at all into higher level human thinking, like the ability to philosophize, conceptualize, integrate knowledge, write a scholarly essay, etc. With that said, some people who've had ECT do not feel damaged by it other than some mild memory loss around the time of the treatment and consider it a life saver. It's possible your psychiatrist is not even aware of this study by Harold Sackeim, because it's published just this month. If you want a copy of this study, just email me and I'll send you a copy of it to give to your doctor. You can visit zaprap.org forums where people discuss their experiences with ECT. Most of the people there, however, are going to be the ones that complain that they have permanent cognitive dysfunction and problems processing and remembering information. The people who don't believe they were damaged by ECT don't post here often.

With regard to vagus nerve stimulation, the evidence for its benefits for depression have been disappointing. As noted in a recent review of the evidence for vagus nerve stimulation, " "a lack of Class I evidence of efficacy in treating depression is currently slowing down adoption by psychiatrists."
Study reference:
["Vagus nerve stimulation for the treatment of depression and other neuropsychiatric disorders." Expert Rev Neurother. 2007 Jan;7(1):63-74. George MS, Nahas Z, Borckardt JJ, Anderson B, Burns C, Kose S, Short EB.]

A minimum of 40% (some researchers say half or more) of depressed patients fail to respond to standard anti-depressants, and this is often after only trying several of them. And when they do work, data from published studies show it can take up to six weeks to begin working, which is a long wait.

I don't know if you've tried it yet, but there is a newly approved transdermal anti-depressant called "Emsam". It is a patch you place on your body and change once daily at your convenience. The patch is like a little square of scotch tape, almost. Anyway, Emsam is different from other commonly prescribed anti-depressants in that it doesn't inhibit the reuptake of neurotransmitters serotonin or norepinephrine. Rather, it prevents the breakdown of different neurotransmitters by acting as an MAO inhibitor. One of the things that makes it different is that it will have a substantial effect on raising levels of "dopamine", while all the other commonly-prescribed anti-depressants do not really affect dopamine levels. (Wellbutrin may have a very small impact on dopamine levels, but mostly all of its action is on norepinephrine). And ironically, the most effective anti-depressant ever developed was Survector (amineptine). This was a specific dopamine reuptake inhibitor (SDRI). One study showed it was efficacious in up to 78% of depressed patients who tried it. It was only on the market for a short time in the U.S. before the FDA banned it. Apparently it was possible to get high on it if one overdosed, and could become addictive for this reason.

MAOI's (like Parnate and Nardil) are not new drugs, in fact they were around before the SSRI's. And the efficacy of MAOI's is superior to the SSRI's and SNRI's you've probably already tried. The reason they have been rarely prescribed prior to the approval of Emsam is that there is potentially a very serious reaction when standard MAOI's are taken with food containing substantial tyramine, like aged cheese, aged meats, soy sauce, and beer on tap. It can cause hypertensive crisis. The transdermal Emsam patch prevents the need for dietary restrictions at the standard dose of 6mg/24. Higher dose patches carry the warning for food interactions as a precaution, but 5 studies were done with the higher dose patches without dietary restrictions and no problems were reported with food interactions. Again, with Emsam you'd still have that six week wait to see if you fee any different. Given that you probably haven't tried a dopamine increasing agent yet, it might be worth a try. (Again, the piddily effect that Wellbutrin has on dopamine doesn't really count.)

As an interesting note about Emsam (generic name selegiline), this drug has been found to consistenly and significantly extend lifespan in healthy animals including rodents and dogs, by over 20%. In other words, it may have some anti-aging properties. It is also often referred to as being a neuroprotectant at lower dosages, while some other antidepressants may actually be neurotoxic, including several of the tricyclics. It also helps to lower levels of oxidative stress in the brain by boosting levels of natural antioxidant enzymes your body makes. In effect, there's some interesting evidence that this drug may do a number of positive things in humans and animals.

All in all, currently available anti-depressants are really unsatisfactory for millions of people and often have no effect on their depression. Some of the newer drugs under development are taking a different approach altogether, but most of these won't be available for years.


Getting back to anti-depressants, I can tell you that even if you did find a drug that helped to you some extent, you can easily defeat the action of the antidepressant by following an unhealthy lifestyle that's likely to lead to depression (example: staying in bed all day and not doing anything). So, you have to be willing to do your part regardless of the drug.

Finally, there's also a drug called Stablon that is only available from overseas, and acts as a serotonin reuptake accelerator rather than an inhibitor. Some of the recent research shows that it may work by increasing neural plasticity. Some people in the U.S. are importing the drug and using it, since its mode of action is unique. But again, many still do not respond to it.

You've probably also heard of seasonal affective disorder that can cause depression. The name can be misleading, because lots of people have this condition year round, it's simply much more common in the winter. It is caused from lack of adequate sunlight, and is treated with special lightboxes and/or spending more time in the sun where possible. Basically, certain wavelengths of light when entering the eyes stimulate the release or shut-off of certain hormones and possibly other chemicals in the body. Apparently, some people require very little sunlight, and others quite a bit more for this purpose.

Answer 2

I've met many people who underwent ECT and most of them said that ECT helped them a lot. But note that sometimes one needs to go through ECT treatments more than once in order to get the needed benefit. My experience with ECT was that a full treatment needed 10 - 14 sessions spread out over several weeks.

I have no knowledge of Vagus.

Answer 3

ECT did work wonders for my suicidal depression. I am bipolar and I was seriously down. The meds were not working. I would recommend it whole heartedly to anyone else who has had similar response to meds and is having no desire for life. My whole family saw a complete turn around. Yes the side affects were major memory problems but as you progress you have to get less and less sessions of the therapy and my Psychiatrist has been suggesting unilateral instead of bilateral treatments which are supposed to cause less harm to your memory. Good luck which ever way you decide to go.