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Doctors at the University of Maryland School of Medicine are testing a "pacemaker for the brain" that may turn out to be a treatment for depression. They think it may work for patients who have not responded to psychotherapy or drugs such as Prozac(r) and Zoloft(r).
The device is a battery-powered electrical pulse generator, implanted under the skin on the upper left side of a patient’s chest. It sends intermittent low-level pulses of electricity to the vagus nerve in the neck. Those pulses, said Mitchell A. Kling, M.D., appear to stimulate an area of the brain that regulates mood.
"This approach has the potential for becoming a breakthrough treatment alternative for patients who have shown only limited improvement with medication and psychotherapy," Kling said. "If effective, vagus nerve stimulation could dramatically improve the quality of life for people with treatment-resistant depression."
Kling is an associate professor of psychiatry and medicine at the UM medical school, and medical director of the Mood Disorder Program at the Baltimore Veterans Administration Medical Center. Nineteen other research centres are participating in a study of the device that is being financed by its manufacturer, Cyberonics, Inc.
The device is called a NeuroCybernetic Prosthesis System or NCP for short. The Food and Drug Administration approved it in 1997 for the treatment of epilepsy. Doctors using it for that purpose noticed that not only did the patients in whom the NCP was implanted have fewer epileptic seizures, but they also experienced a dramatic improvement in their mood. This led to a pilot study of its use for patients with treatment-resistant depression, which found that 40 percent of those who had an NCP installed, experienced significant relief from their depression symptoms.
The stimulus apparently travels through the vagus nerve to the mood-related limbic area of the brain. A major carrier of information from the brain to the heart, lungs and other parts of the body, the vagus nerve is involved with regulation of the heart rhythm, the voice and swallowing.
Kling said patients feel no pain when the stimulation is applied, which is normally every five minutes. A few experienced minor hoarseness or a slight change in voice quality.
