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    The Globe and Mail, Tuesday, November 28, 2000

    Vagus nerve may be key to depression
    New stopwatch-sized implant uses nerve to regulate brain's emotional

    By Allison Schlesinger

    Many patients with the kind of depression that sabotages the ability to
    form relationships or keep jobs have long believed that medicines or shock
    therapy were their only hope.

[Fred A. Baughman Jr., MD:
Here the writer speaks of ‘kinds of depression’ as if there
prove-able subtypes; as if depression were a disease. No such thing is
true. Depression is a normal response in normal human beings to
depressing situations and circumstances.]

    But medical researchers are examining how a surgically implanted
    stopwatch-sized device could offer an alternative treatment for profound

    Robert Howland, an associate professor at the University of Pittsburgh
    Medical Center's Western Psychiatric Institute and Clinic, said the
    vagus-nerve stimulator acts like a pacemaker for the brain. Just as a

    cardiac pacemaker uses electric pulses to regulate the heart, so the
    stimulator uses electric pulses to regulate the brain.

[Fred A. Baughman Jr., MD:
Always the medical metaphors. In the case of cardiac pacemakers,
there is always a definite disease of the heart, usually one causing
demonstrable EKG, heart rhythm abnormalities. In the case of treating
depression with a vagus-nerve stimulator, while it is certain that the
vagus-nerve stimulation alters the brain in some way or ways, it’s use
in a patient who feels depressed but who has no demonstrable organic
disease—not of the brain, not of the body. The depression speaks of the
persons mood. Imagine the powerful therapeutic images conjure up in the
patient’s mind in having an operation, which, even if a word isn’t
spoken, is most assuredly being done to relieve his depression—his
disease—his chemical imbalance. I cannot imagine an ethics committee,
in a democracy, letting this sort of thing be done]

    Originally designed and used to treat epileptic seizures, the stimulator
    sends pulses to the brain stem through the vagus nerve, which stretches
    through the neck near the carotid artery.

[Fred A. Baughman Jr., MD:
Epilepsy, which does come in many forms, is a real disease in which
their are abnormal electrical discharges from damaged parts of the
brain. These abnormal discharges are somehow beneficially altered in
patients whose seizures lessen with VNS. Again, as in cardiac rhythm
abnormalities, an actual physical abnormality has been
identified/verified and is being treated in a logical way using a
scientific/medical approach. In depression, or any other
psychiatric/emotional condition/disorder, there is no disease. It is
quite as if young children were to play doctor and make up diseases,
only the drugs and shock therapy and psychosurgery that psychiatry
brings to bear is very real and poses, for the unwary patient, the only
physical risk to which they will be exposed.]

    The pulses usually last about 30
    seconds and happen every three to five minutes. The circular device is made
    from materials that are used in pacemakers, and sits in the chest with
    small wires leading to the vagus nerve. The nerve is a powerful path
    between the brain and the body, and reaches the section of the brain that
    controls emotion, called the limbic system, Dr. Howland said.

    Tests conducted on patients who used the stimulator to treat depression
    showed that the device increased activity in the thalamus and the brain
    stem. Tests also showed that increased blood flow in areas of the brain
    stem known to be related to depression.

[Fred A. Baughman Jr., MD:
Changes in the heart rate, blood pressure, sweating, pupils size,
etc. seen in depressed persons are not physical abnormalities, but the
physical concomitants of the depressed emotional state. The physical
concomitants of anxiety are quite different.]

    Unlike medications that go through the bloodstream and chemically
    affect these sections of the brain, the stimulator takes a short cut,
    Dr. Howland said.

    A pilot study conducted last year, involving 20 U.S. research centres,
    prompted researchers to think the stimulator might be useful for patients
    who were not helped by antidepressants and/or shock treatment.

    Researchers say the stimulator helped 12 of 30 patients in the pilot study.

[Fred A. Baughman Jr., MD:
At a rate less than placebo, it seems. At Harvard University,
psychosurgery, which, no doubt, is brain-damaging, is done of so-called
OCD or obsessive-compulsive disorder—represented, but never proven to be
a disease. Meanwhile, John Q. Public scratches his head and thinks: "By
golly, if they put an implant in, like the vagus stimulator, and if they
do brain surgery for it, there’s no way they couldn’t have a brain
disease. What is it they say about lying—"If you’re going to tell a lie,
tell a big lie".]

    Patients who experienced positive results did not notice them immediately
    after the surgery, and some used the stimulator along with talk therapy and


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