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Pacemakers -- for Anxiety

Anxiety -- the Nerve

Reason for Hope

George says there is reason for hope.


For the last 10 years, VNS has been successful treating patients with epilepsy who do not respond to conventional therapy. Stimulating the vagus nerve appears to reduce the number of daily seizures such people experience by up to 40% -- and some patients become completely seizure-free, George says.


VNS was approved by the FDA for treatment-resistant epilepsy in 1997.


VNS has also shown promise in the treatment of depression. It is approved for this use in Europe and in Canada, but not in the U.S.


In a report published last year in the Journal of the Society of Biological Psychiatry, 30 people with depression, who were not helped by common medications, received VNS. Forty percent of the patients showed some improvement after the treatment, according to the study.


Remarkably, some patients appeared to have no depression at all after the treatment.


"What got me interested was the fact that 20% to 25% of patients were completely well after treatment," says George, a co-author of the study. "Among people with treatment-resistant depression, you rarely see complete remission. These were people who had failed on three or four medications, and two-thirds of the group had had electroconvulsive therapy [ECT, the so-called shock treatment]."


A new study will compare VNS to other treatments for depression, and to no treatment. In the meantime, its apparent success with depression whets his appetite for trying the therapy with other mood disorders, including anxiety.


George says he believes there is even more reason to believe that VNS will be successful in treating anxiety because of the critical interaction between physical responses in the body -- for instance, heart rate and muscle spasms -- and the experience of fear or panic in the brain. That entire interaction occurs through the vagus nerve.


"It makes a lot of sense that you could change that interaction by manipulating the information through stimulation of the vagus," George says.


Because VNS requires surgical implantation, it is far more invasive than other electrical stimulation techniques, such as ECT or transcranial magnetic stimulation (TMS), which don't require cutting the body. And it is not cheap: The device and surgery cost approximately $20,000.


Other psychiatrists are intrigued by the success of VNS in depression, but say its practical use as a treatment remains to be seen. Richard Weiner, MD, leads the American Psychiatric Association's Committee on Electroconvulsive Therapy.


"It's an invasive technique," Weiner tells WebMD. "You need to have some justification for using it. It's never going to be something people run to do first. The issue is, once you have gone through a trial of medications, at what point do you use this?"


For Gray Scott, participating in George's study was a chance to try a cutting-edge treatment that could prove a permanent solution to the anxiety plaguing her for nearly a decade. If it doesn't work, Scott says she will have the device removed. If it does, she will leave it in indefinitely.

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