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Pacemakers -- for Anxiety

Anxiety -- the Nerve

WebMD Feature

Sept. 24, 2001 -- Gray Scott, of Florence, S.C., has been treated for anxiety for nine years, from the time she was diagnosed with an eating disorder at age 15. Since then, she has tried a variety of medications and psychotherapy, with variable results.


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"When the symptoms are alleviated, it becomes tolerable," she tells WebMD. "At their worst, I have felt very desperate."


Scott is not alone. Anxiety disorders -- including phobias, panic attacks, obsessive-compulsive disorders, and posttraumatic stress disorder -- affect more than 23 million Americans. Although treatment with a combination of drugs and therapy is very often successful, some patients go from drug to drug, and therapy to therapy, with no relief.


"Most people think of anxiety disorders as not terribly devastating, and easily treatable with drugs," says psychiatrist Mark George, MD, director of the brain stimulation laboratory at the Medical University of South Carolina in Charleston. "But there is a substantial core of people for whom drugs don't work and for whom there are no good alternatives."


That may change, however, if a new surgical treatment called vagus nerve stimulation, or VNS, proves successful.


On May 18, Scott became one of the first anxiety patients to receive the experimental treatment. On that day, surgeons at the Medical College of South Carolina implanted a device in her chest, similar to a heart pacemaker, and wired it to electrically stimulate the vagus nerve in her neck.


Named for the Latin word meaning "wandering," the vagus nerve meanders from the colon, past the intestines, heart, and lungs, and comes together at the diaphragm, where it runs as a thick cable past the esophagus and into the brain.


George calls the nerve "an information superhighway to the brain." Contrary to long-held wisdom, the traffic on that highway is mostly going north -- from the body to the brain, not vice versa, he says.


"Most people have thought of it as the way the brain controls the heart and the guts," George explains. "In fact, most of the information is actually going in the other direction. The vagus nerve is really the brain's way of interpreting what is happening in the heart and the guts."


That suggests an intriguing theoretical reason why VNS might work well for people with anxiety, he says.


"Emotions are not brain events, but the brain's interpretation of bodily events," George says. "When you feel scared, it's really your brain sensing that your heart rate is going up."


So by stimulating the vagus nerve, George and others hope to influence the exchange of information between body and brain, and thereby relieve the symptoms of anxiety.


Whether this works remains to be seen. Today, the device implanted in Scott's chest activates every five minutes, stimulating her vagus nerve with a small electrical current for a period of five seconds. When it activates while she is talking, her voice suddenly becomes mildly hoarse.


"Some days I think it's helping, and some days I don't know," she says. "At first I was expecting something instantaneous, but it doesn't work that way. It can take months to see any results."

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