
Vagus Nerve Stimulation Improves Treatment-Resistant Depression Outcomes - laurex
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2017.16010034
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BugsJustFindMe
Vagus nerve stimulation, eh? As in the infamous cure for intractable
hiccups[0]?

I mean...of course that improves depression outcomes. How could it not?

[0] -
[https://www.ncbi.nlm.nih.gov/pubmed/2299306](https://www.ncbi.nlm.nih.gov/pubmed/2299306)

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himom
This is invasive (iVNS), which means installing a box in the patient’s chest
and wrapping electrodes around the left VNS in the neck. :/

There have been studies on transcutaneous VNS (tcVNS) of the left ear as well.

[https://bmccomplementalternmed.biomedcentral.com/articles/10...](https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-12-255)

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perl4ever
I sincerely wish there was more research into how to _measure_ depression in
the first place. If you don't define the problem, you can't begin to search
for a solution. My understanding is that we have nothing better to guide
clinical studies than giving surveys asking how people feel. We need
equivalents of finger-stick blood sugar tests and A1C tests for mental
illness.

~~~
phkahler
That's a really simplistic view of a complicated problem. For an example of
why that can't work, read about the studies on the relatives of actress Glenn
Close. One is bipolar and one scizophrenic. Both were found to have a genetic
variant that might be summarised as causing a glycine deficiency (possibly
just in the brain IDK). Treating them with high doses of glycine eliminates
symptoms in both of them. It seems unlikely that even checking blood levels
would indicate a problem. Perhaps a genetic test? But this is apparently not a
common genetic marker in those two conditions.

Another solution in some cases is to change a person's environment,
relationships, job, etc... Some depression can be relieved by changing ones
worldview or other purely psychological interventions.

In short, the notion of objective physical measures indicating specific
conditions is not possible in most cases.

SSRIs are used to increase serotonin levels, but they dont even use a
serotonin test to diagnose. I have my suspicion that there's not a strong
correlation.

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amelius
Perhaps functional MRI could help make a diagnosis of depression? Even with
different underlying causes, a classification could perhaps be made based on
imaging.

[https://en.wikipedia.org/wiki/Functional_magnetic_resonance_...](https://en.wikipedia.org/wiki/Functional_magnetic_resonance_imaging)

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perl4ever
You can talk about MRIs, or genes, or serotonin all day, but that doesn't mean
you know what depression (or other mental state) is - using the current tools
you _assume_ you know what it is and that is the problem.

One way to measure objectively is to look at whether someone is employable and
maintains employment. But that is far too low resolution and non specific.
People change their mood during a day and from one day to a next, and there
must be physical correlates in principle.

There is a huge human cost to the fact that nobody knows what they are doing,
because they cannot relate treatment to anything objective. Sometimes a drug
seems to be not working well after several years, and the dosage is raised,
and all the while the side effect of the drug is what's causing the problem,
so it gets worse the higher the dosage goes. In the mean time, that person
becomes unable to work, and is caught in a series of catch-22s.

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cpncrunch
It's open label, so we have no idea how much is due to the placebo effect
(which is always large in studies with novel treatments like this, especially
for depression).

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starpilot
Less significant for treatment-resistant depression, I imagine. They've been
through this before and might have pretty dampened expectations.

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MisterOctober
I've anecdotally observed a trend of clinicians more centrally considering the
role of nerves in psychological disorders. Like back in Bertie Wooster's day,
when shrinks were called "nerve specialists" and many preparations marketed as
mood enhancers referred to as "nervine tonics"

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perl4ever
The book "Memoirs of My _Nervous_ Illness"[1] comes to mind.

[1]
[https://www.goodreads.com/book/show/287490.Memoirs_of_My_Ner...](https://www.goodreads.com/book/show/287490.Memoirs_of_My_Nervous_Illness)

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fao_
How exactly are they stimulating it?

~~~
himom
Think pacemaker.

