DEPRESSION
symptoms, treatments & medical costs
symptoms, treatments & medical costs
DEPRESSION
Zhion.com July 19, 2005
Depression is not just feeling 'a bit down' or a sign of weakness. Depression has a
profound effect on daily life; it is related to stress and neurotransmitters imbalance.
The symptoms for a person suffered from depression may include unhappy mood,
anxiety or irritability, lack of interest or enjoyment in daily life, withdrawal from the
outside world, general slowing of mental activity, indecision and difficulty in thinking
clearly, loss of concentration and poor memory, loss of interest in dress and
appearance, feelings of guilt, hypochondria, loss of libido, restless preoccupation with
morbid, pessimistic thoughts and feeling that there is no future, and thoughts of
suicide, sleep disturbance, poor appetite, (weight loss) or overeating (weight gain),
constipation, unexplained pains or aching discomfort anywhere in the body, constant
fatigue and listlessness. [1-2].
HOW DOES DEPRESSION AFFECT OUR SOCIETY?
In any given year, approximately 19 million American adults ages 18 and older
experience depression [3]. Over the course of a lifetime, depression will affect one in
five people [4]. Depression is two to three times more likely in women than men. [5]
Total annualized health care costs for treating depression are highest for hospitalized
patients with treatment-resistant depression, resulting from significantly greater general
medical and depression-related hospitalization costs.[14] Depression costs the United
States approximately $80 billion annually in both direct and indirect costs including
medical expenses, days missed from work, lost productivity and premature death. [6]
Depression is the leading cause of disability in the United States and the fourth most
disabling medical condition worldwide. By 2020, it is predicted that depression will be
the second most disabling condition worldwide. [7]
HOW DOES DEPRESSION AFFECT INDIVIDUALS (STATISTICAL DATA)?
A person with depression is 35 times more likely to commit suicide than one who does
not have depression [11] and 15 percent of patients who have been hospitalized for
depression commit suicide.[12]
Research shows that severe depression also heightens the risk of dying after a heart
attack or stroke, and depression often reduces the quality of life for cancer patients
and may reduce survival time. [13]
Approximately 50 percent of patients in their first major depressive episode will
experience at least one more episode of major depression.[15]
More than 40 percent of patients experience a recurrence of depression after two
years and more than 60 percent experience recurrence after five years.[16]
Eighty to 90 percent of those patients having experienced two or more episodes of
depression will have further occurrences. [17]
Subsequent episodes of depression are often of longer duration, more severe and less
responsive to treatment. [18]
TWO POPULAR DEPRESSION CLASSIFICATIONS
ENDOGENOUS VS REACTIVE DEPRESSION Endogenous depression similar to
primary depression, arises 'from within'. Reactive depression (or exogenous
depression) rises following an unhappy life event.
PSYCHOTIC VS NEUROTIC DEPRESSION In psychotic depression, the patient
experiences psychiatric symptoms such as hallucinations, delusions and disorientation
etc. While, in neurotic depression, patient does not experience psychiatric symptoms
but he or she may have neurotic symptoms such as anxiety and phobia.
TRADITIONAL TREATMENTS FOR DEPRESSION
MEDICAL TREATMENTS Depending on the form of depression and severity of
symptoms, there are a variety of antidepressant medications and psychotherapies that
can be used to treat depression. Some people with mild depression do well with
psychotherapy alone. Others with more moderate to severe depression often benefit
from antidepressants. Some studies have demonstrated that a combination of
psychotherapy and antidepressant medication may be effective in some patients.
ELECTROCONVULSIVE THERAPY (ECT) Electroconvulsive therapy is generally
offered to individuals with severe or life threatening depression or for those who cannot
take antidepressant medication.[8] This procedure involves inducing a seizure by
stimulating the brain through electrodes placed on the head to deliver electrical
impulses. Electroconvulsive therapy is performed under anesthesia, so the individual
receiving Electroconvulsive therapy does not consciously experience the electrical
stimulus and subsequent seizure.[9]. However, patients with treatment-resistant
depression are at high risk for relapse within one year following ECT response.[24]
--->TREATMENT-RESSISTANT DEPRESSION
Research to identify the overall number of Americans with treatment-resistant
depression is ongoing, but experts agree that approximately 20 percent to 25 percent
of people with major depressive disorder may have treatment-resistant depression.
According to a Datamonitor report, up to 4.4 million Americans may experience
treatment-resistant depression in any given year. [19]
Treatment-resistant depression is a disabling chronic illness that is associated with a
high degree of hopelessness and prominent suicidal ideation.[20] One-third of patients
with treatment-resistant depression have significant suicidal ideas or gestures. [22]
According to published studies, patients with treatment-resistant depression have more
than six times the average medical costs of patients who are not experiencing
treatment-resistant depression ($42,344 vs. $6,512). [21] Expensive diagnostic device
such as magnetic resonance imaging (MRI) is required to reveal the specific brain
morphologic changes and degeneration associated with treatment-resistant
depression. [23]
VAGUS NERVE STIMULATOR
Recently, the government approved Cyberonics Inc.'s vagus nerve stimulator (VNS) for
the severely depressed who have run out of treatment options: a pacemaker-like
implant that sends tiny electric shocks to the brain. The Food and Drug
Administration's clearance opens vagus nerve stimulator (VNS) as a potential
treatment for an estimated 4 million Americans with hard-to-treat depression - despite
controversy over whether it's really been proven to work. Actually, this pacemaker-like
implant has been sold since 1997 to control intractable epilepsy, a much smaller
market. A generator the size of a pocket watch is implanted into the chest. Wires snake
up the neck to the vagus nerve, delivering tiny electric shocks through that nerve and
into a region of the brain thought to play a role in mood.
Cyberonics began a 200-patient study (without a comparison group) to see whether
vagus nerve stimulator could treat depression patients not adequately helped by other
therapies. Two years later, a third of patients in the original study had experienced
some response and between 17 percent and 20 percent were in remission.
The chief risk for this device: is temporary voice alteration - a hoarseness or raspiness,
or voice "breaks". Other complications include breathing difficulty and swallowing
difficulty. However, there was no sign of increased deaths in the depression study.To
obtain more information about vagus nerve stimulator: 1-877-NOW-4-VNS or visit www.
VNSTherapy.com.
ACKNOWLEGEMENT
ZHION specially thanks Cyberonics, Inc., for providing the statistical data about
depression and information about their product-vagus nerve stimulator (VNS).
HOME
THIS ARTICLE IS FOR YOUR INFORMATION ONLY. IF YOU HAVE ANY QUESTION,
PLEASE, CONSULT WITH YOUR DOCTOR IMMEDIATELY.
ALL RIGHT RESERVED.
References
1. National Institute of Health Pub. No. 02-3561. 2. National Institute of Health Pub. No. 01-4591. 3
National Institute of Health, “What to do when a friend is depressed,” Pub. No. 01-3824. 4
Melancholy Nation, U.S. News and World Report, March 8, 1999, pages 56–63. 5 National Institute
of Health Pub. No. 01-4584 6 Greenberg PE et al. “The economic burden of depression in the
United States: how did it change between 1990 and 2000?,” Journal of Clinical Psychiatry. 64(12):
1465, December 2003: 75. 7 Fava, M. “Background and Rationale for the Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) study.” Psychiatr Clin N Am 26 (2003) page 459. 8
Frank E, Karp JF, Rush AJ (1993). “Efficacy of treatments for major depression.”
Psychopharmacology Bulletin; 1993. 29:457-75. 9 National Institute of Health, “Depression,” Pub.
No. 02-3561. 11 Melancholy Nation, U.S. News and World Report, March 8, 1999, pages 56–63. 12
Nordenberg L. “Dealing with the Depths of Depression.” FDA Consumer Magazine, July–August
1998. 13 Nemeroff C. “The Neurobiology of Depression.” Scientific American, June 1998, page 44.
14 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care Utilization and Costs,
” J. Clin Psychiatry; 2002. 63:11. 15 Keller M, Boland R. “Implications of Failing to Achieve
Successful Long-Term Maintenance Treatment of Recurrent Unipolar Major Depression.” Biol
Psychiatry; 1998. 44:351. 16 Keller, MB, Boland R. “Implications of Failing to Achieve Successful
Long-Term Maintenance Treatment of Recurrent Unipolar Major Depression.” Biol Psychiatry; 1998.
44(5):351. 17 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care Utilization
and Costs,” J. Clin Psychiatry; 2002. 63:11. 18 Zajecka J. “Clinical Issues in Long-Term Treatment
With Antidepressants.” J Clin Psychiatry; 2000. 61:20. 19 Datamonitor Report “Vagus Nerve
Stimulation: The potential impact on pharmacotherapy in epilepsy and mood disorders.” May 2001.
20 Papakostas GI, Petersen T, Pava J, et al. Hopelessness and suicidal ideation in outpatients with
treatment-resistant depression: prevalence and impact on treatment outcome. J Nerv Ment Dis;
2003. 191:444-449. 21 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care
Utilization and Costs.” J. Clin Psychiatry; 2002. 63:11. 22 Papakostas GI, Petersen T, Pava J, et al.
Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence
and impact on treatment outcome. J Nerv Ment Dis; 2003. 191:444-449. 23 Amsterdam JD, Greden
JF, Nierenberg AA, Thase ME. “Treatment Resistant Depression.” J Clin Psychiatry Intercom.
August 2000, 1–2. 24 Sackeim HA, Prudic J, Devanand DP, Decina P, Kerr B, Malitz S. The impact of
medication resistance and continuation pharmacotherapy on relapse following response to
electroconvulsive therapy in major depression. J Clin Psychopharmacol; 1990. 10:96-104.
Zhion.com July 19, 2005
Depression is not just feeling 'a bit down' or a sign of weakness. Depression has a
profound effect on daily life; it is related to stress and neurotransmitters imbalance.
The symptoms for a person suffered from depression may include unhappy mood,
anxiety or irritability, lack of interest or enjoyment in daily life, withdrawal from the
outside world, general slowing of mental activity, indecision and difficulty in thinking
clearly, loss of concentration and poor memory, loss of interest in dress and
appearance, feelings of guilt, hypochondria, loss of libido, restless preoccupation with
morbid, pessimistic thoughts and feeling that there is no future, and thoughts of
suicide, sleep disturbance, poor appetite, (weight loss) or overeating (weight gain),
constipation, unexplained pains or aching discomfort anywhere in the body, constant
fatigue and listlessness. [1-2].
HOW DOES DEPRESSION AFFECT OUR SOCIETY?
In any given year, approximately 19 million American adults ages 18 and older
experience depression [3]. Over the course of a lifetime, depression will affect one in
five people [4]. Depression is two to three times more likely in women than men. [5]
Total annualized health care costs for treating depression are highest for hospitalized
patients with treatment-resistant depression, resulting from significantly greater general
medical and depression-related hospitalization costs.[14] Depression costs the United
States approximately $80 billion annually in both direct and indirect costs including
medical expenses, days missed from work, lost productivity and premature death. [6]
Depression is the leading cause of disability in the United States and the fourth most
disabling medical condition worldwide. By 2020, it is predicted that depression will be
the second most disabling condition worldwide. [7]
HOW DOES DEPRESSION AFFECT INDIVIDUALS (STATISTICAL DATA)?
A person with depression is 35 times more likely to commit suicide than one who does
not have depression [11] and 15 percent of patients who have been hospitalized for
depression commit suicide.[12]
Research shows that severe depression also heightens the risk of dying after a heart
attack or stroke, and depression often reduces the quality of life for cancer patients
and may reduce survival time. [13]
Approximately 50 percent of patients in their first major depressive episode will
experience at least one more episode of major depression.[15]
More than 40 percent of patients experience a recurrence of depression after two
years and more than 60 percent experience recurrence after five years.[16]
Eighty to 90 percent of those patients having experienced two or more episodes of
depression will have further occurrences. [17]
Subsequent episodes of depression are often of longer duration, more severe and less
responsive to treatment. [18]
TWO POPULAR DEPRESSION CLASSIFICATIONS
ENDOGENOUS VS REACTIVE DEPRESSION Endogenous depression similar to
primary depression, arises 'from within'. Reactive depression (or exogenous
depression) rises following an unhappy life event.
PSYCHOTIC VS NEUROTIC DEPRESSION In psychotic depression, the patient
experiences psychiatric symptoms such as hallucinations, delusions and disorientation
etc. While, in neurotic depression, patient does not experience psychiatric symptoms
but he or she may have neurotic symptoms such as anxiety and phobia.
TRADITIONAL TREATMENTS FOR DEPRESSION
MEDICAL TREATMENTS Depending on the form of depression and severity of
symptoms, there are a variety of antidepressant medications and psychotherapies that
can be used to treat depression. Some people with mild depression do well with
psychotherapy alone. Others with more moderate to severe depression often benefit
from antidepressants. Some studies have demonstrated that a combination of
psychotherapy and antidepressant medication may be effective in some patients.
ELECTROCONVULSIVE THERAPY (ECT) Electroconvulsive therapy is generally
offered to individuals with severe or life threatening depression or for those who cannot
take antidepressant medication.[8] This procedure involves inducing a seizure by
stimulating the brain through electrodes placed on the head to deliver electrical
impulses. Electroconvulsive therapy is performed under anesthesia, so the individual
receiving Electroconvulsive therapy does not consciously experience the electrical
stimulus and subsequent seizure.[9]. However, patients with treatment-resistant
depression are at high risk for relapse within one year following ECT response.[24]
--->TREATMENT-RESSISTANT DEPRESSION
Research to identify the overall number of Americans with treatment-resistant
depression is ongoing, but experts agree that approximately 20 percent to 25 percent
of people with major depressive disorder may have treatment-resistant depression.
According to a Datamonitor report, up to 4.4 million Americans may experience
treatment-resistant depression in any given year. [19]
Treatment-resistant depression is a disabling chronic illness that is associated with a
high degree of hopelessness and prominent suicidal ideation.[20] One-third of patients
with treatment-resistant depression have significant suicidal ideas or gestures. [22]
According to published studies, patients with treatment-resistant depression have more
than six times the average medical costs of patients who are not experiencing
treatment-resistant depression ($42,344 vs. $6,512). [21] Expensive diagnostic device
such as magnetic resonance imaging (MRI) is required to reveal the specific brain
morphologic changes and degeneration associated with treatment-resistant
depression. [23]
VAGUS NERVE STIMULATOR
Recently, the government approved Cyberonics Inc.'s vagus nerve stimulator (VNS) for
the severely depressed who have run out of treatment options: a pacemaker-like
implant that sends tiny electric shocks to the brain. The Food and Drug
Administration's clearance opens vagus nerve stimulator (VNS) as a potential
treatment for an estimated 4 million Americans with hard-to-treat depression - despite
controversy over whether it's really been proven to work. Actually, this pacemaker-like
implant has been sold since 1997 to control intractable epilepsy, a much smaller
market. A generator the size of a pocket watch is implanted into the chest. Wires snake
up the neck to the vagus nerve, delivering tiny electric shocks through that nerve and
into a region of the brain thought to play a role in mood.
Cyberonics began a 200-patient study (without a comparison group) to see whether
vagus nerve stimulator could treat depression patients not adequately helped by other
therapies. Two years later, a third of patients in the original study had experienced
some response and between 17 percent and 20 percent were in remission.
The chief risk for this device: is temporary voice alteration - a hoarseness or raspiness,
or voice "breaks". Other complications include breathing difficulty and swallowing
difficulty. However, there was no sign of increased deaths in the depression study.To
obtain more information about vagus nerve stimulator: 1-877-NOW-4-VNS or visit www.
VNSTherapy.com.
ACKNOWLEGEMENT
ZHION specially thanks Cyberonics, Inc., for providing the statistical data about
depression and information about their product-vagus nerve stimulator (VNS).
HOME
THIS ARTICLE IS FOR YOUR INFORMATION ONLY. IF YOU HAVE ANY QUESTION,
PLEASE, CONSULT WITH YOUR DOCTOR IMMEDIATELY.
ALL RIGHT RESERVED.
References
1. National Institute of Health Pub. No. 02-3561. 2. National Institute of Health Pub. No. 01-4591. 3
National Institute of Health, “What to do when a friend is depressed,” Pub. No. 01-3824. 4
Melancholy Nation, U.S. News and World Report, March 8, 1999, pages 56–63. 5 National Institute
of Health Pub. No. 01-4584 6 Greenberg PE et al. “The economic burden of depression in the
United States: how did it change between 1990 and 2000?,” Journal of Clinical Psychiatry. 64(12):
1465, December 2003: 75. 7 Fava, M. “Background and Rationale for the Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) study.” Psychiatr Clin N Am 26 (2003) page 459. 8
Frank E, Karp JF, Rush AJ (1993). “Efficacy of treatments for major depression.”
Psychopharmacology Bulletin; 1993. 29:457-75. 9 National Institute of Health, “Depression,” Pub.
No. 02-3561. 11 Melancholy Nation, U.S. News and World Report, March 8, 1999, pages 56–63. 12
Nordenberg L. “Dealing with the Depths of Depression.” FDA Consumer Magazine, July–August
1998. 13 Nemeroff C. “The Neurobiology of Depression.” Scientific American, June 1998, page 44.
14 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care Utilization and Costs,
” J. Clin Psychiatry; 2002. 63:11. 15 Keller M, Boland R. “Implications of Failing to Achieve
Successful Long-Term Maintenance Treatment of Recurrent Unipolar Major Depression.” Biol
Psychiatry; 1998. 44:351. 16 Keller, MB, Boland R. “Implications of Failing to Achieve Successful
Long-Term Maintenance Treatment of Recurrent Unipolar Major Depression.” Biol Psychiatry; 1998.
44(5):351. 17 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care Utilization
and Costs,” J. Clin Psychiatry; 2002. 63:11. 18 Zajecka J. “Clinical Issues in Long-Term Treatment
With Antidepressants.” J Clin Psychiatry; 2000. 61:20. 19 Datamonitor Report “Vagus Nerve
Stimulation: The potential impact on pharmacotherapy in epilepsy and mood disorders.” May 2001.
20 Papakostas GI, Petersen T, Pava J, et al. Hopelessness and suicidal ideation in outpatients with
treatment-resistant depression: prevalence and impact on treatment outcome. J Nerv Ment Dis;
2003. 191:444-449. 21 Crown, W. “The Impact of Treatment-Resistant Depression on Health Care
Utilization and Costs.” J. Clin Psychiatry; 2002. 63:11. 22 Papakostas GI, Petersen T, Pava J, et al.
Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence
and impact on treatment outcome. J Nerv Ment Dis; 2003. 191:444-449. 23 Amsterdam JD, Greden
JF, Nierenberg AA, Thase ME. “Treatment Resistant Depression.” J Clin Psychiatry Intercom.
August 2000, 1–2. 24 Sackeim HA, Prudic J, Devanand DP, Decina P, Kerr B, Malitz S. The impact of
medication resistance and continuation pharmacotherapy on relapse following response to
electroconvulsive therapy in major depression. J Clin Psychopharmacol; 1990. 10:96-104.
Depression-Terms and Frequent Ask Questions
Antidepressant medication There are four classes of antidepressants: Tricyclic
Antidepressants (TCAs); Monoamine Oxidase Inhibitors (MAOIs); Selective Serotonin
Reuptake Inhibitors (SSRIs) and “atypical antidepressants” which include other
mechanisms of action.
Anxiety disorders: Anxiety disorders are a group of emotional illnesses including phobias,
panic attacks, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD)
and post-traumatic stress disorder.
Bipolar disorder: Commonly known as manic depressive illness, bipolar disorder involves
mood swings from “high” episodes of mania to periods of depression. Between
episodes, the people with bipolar disorder often experience the normal range of moods.
Manic episodes are distinguished by feelings of euphoric happiness, irritability and high
levels of energy.
Cingulotomy: A surgical technique that interrupts the cingulate gyrus, a bundle of nerve
fibers in the front of the brain, by applying heat or cold. This procedure has been used to
treat obsessive compulsive disorder.
Clinical depression: Emotional experiences of sadness, loss or mood states that are
persistent and can interfere significantly with an individualÂ’s ability to function.
Cognitive behavioral therapy (CBT): According to proponents of this psychotherapy
approach, how you feel is the result of how you think. Cognitive therapists help patients
identify distorted or negative ways of thinking and replace them with more positive
perceptions. Depression is relieved by altering an unrealistically negative view of ones
self and the world. People with major depression or anxiety disorders may benefit most
from CBT according to The Journal of Rational-Emotive & Cognitive-Behavior Therapy.
Chronic or recurrent depression: A major depressive episode that is of at least two years
in duration is called chronic depression. When multiple depressive episodes occur over
time, this is called recurrent depression.
Dysthymic disorder (formerly known as dysthymia): A long lasting, persistent, mild
depression lasting at least two years, often accompanied by major depressive episodes.
Electroconvulsive therapy (ECT): A treatment usually for the symptoms of severe and/or
psychotic depression, ECT is the application of an electrical current through electrodes
applied to the patientÂ’s head to induce a seizure. ECT is performed under anesthesia
and the amount of electricity needed to induce a seizure varies considerably from patient
to patient. The treatments are repeated two or three times per week until clinical
improvements are achieved. Typical courses of ECT are six to ten treatments. Relapse
rates are high, and many patients experience memory impairment.
Failed adequate treatment: Failure to respond to electroconvulsive therapy or an
established antidepressant drug administered at an adequate dose for an adequate
duration.
Interpersonal therapy (IPT): Short-term therapy that concentrates on relationships as the
key to understanding and overcoming emotional difficulties. The overall goal of IPT is to
relieve symptoms of depression, improve self-esteem and help patients get what they
want or need from relationships in a positive way. The bond that the client develops with
the therapist is a crucial component of this therapy.
Major depression: A severe form of depression characterized by having five or more
symptoms of depression (as defined by DSM IV) during the same two week period.
Symptoms include intense sadness, feelings of hopelessness, a sudden change in
appetite or weight and a loss of pleasure and interest in normal activities.
Major depressive disorder: Mood disorder characterized by one or more episodes of
major depression.
Major depressive episode: Meets the criteria for being in a current episode of major
depression.
Mania: An acute mood characterized by euphoria, a sense of well-being and an increase
in activity level. One of the two mood cycles experienced in bipolar disorder.
Manic Depression or manic depressive illness: See Bipolar Disorder
Neurotransmitters: Chemicals used by brain cells to communicate.
Psychiatrists: Licensed medical doctors who specialize in diagnosing and treating mental
illness. They provide counseling and can prescribe medications.
Psychologists: Psychologists may have a Ph.D. in psychology or a Psy.D. (doctorate in
clinical psychology). However, they do not study medicine and cannot prescribe
medication.
Psychotherapy: The treatment of emotional or mental disorders by counseling. Most
mental health professionals tailor their approach to the needs, problems and personality
of the person seeking help, and they may combine different techniques in the course of
therapy. Many individuals are turning to short-term psychotherapy which may last several
weeks to several months. Most likely to benefit are those interested in solving an
immediate problem.
Remission: Remission is defined as the absence of depressive symptoms and the return
of psychosocial functioning for at least six months. Patients with depression who achieve
remission no longer meet the criteria for major depression.
Response: Response is defined as at least a 50 percent reduction in the Hamilton Rating
Scale for Depression (HAM-D) scores. Response may be a partial improvement in
symptoms rather than a state of being completely symptom-free.
Selective Serotonin Reuptake Inhibitors (SSRIs): Medications, such as fluoxetine
(Prozac), sertaline (Zoloft) and paroxetine (Paxil), which alter brain chemistry and relieve
depressive symptoms by affecting the neurotransmitter serotonin. These drugs can be
used in conjunction with psychotherapy or as the primary treatment.
Treatment-resistant depression (TRD): While definitions of treatment-resistant
depression may differ, most psychiatrists agree that treatment-resistant depression is a
major depressive episode that has not had an adequate response to at least two classes
of adequate antidepressants at appropriate dose and duration. At least 20 percent of all
patients with major depression may experience treatment-resistant depression.
Unipolar major depression: A person who has five or more depression symptoms (as
defined by DSM IV) and experiences impairment in usual functioning nearly every day
during the same two-week period. It typically occurs in discrete episodes that happen
over a personÂ’s lifetime.
Vagus nerve: The tenth cranial nerve. A mixed nerve that has both motor and sensory
function.
Vagus Nerve Stimulation (VNSÔ) Therapy System: VNS Therapy is approved for the
adjunctive long-term treatment of chronic or recurrent depression for patients 18 years of
age or older who are experiencing a major depressive episode and have not had an
adequate response to four or more adequate antidepressant treatments. VNS Therapy
consists of an implanted pacemaker-like device that delivers mild, intermittent pulses that
are sent to the vagus nerve, which then modulates activity in various areas of the brain
thought to be involved in mood regulation. The VNS Therapy System is at various levels
of investigational clinical study as a potential treatment for anxiety disorders, AlzheimerÂ’s
disease, chronic headache/migraine and bulimia.
Frequently Asked Questions About Depression
What is depression?
Depression, or depressive disorder, is a serious illness that involves the body, mood and
thoughts. Depression may affect many aspects of a personÂ’s life: from the way a person
feels about him or herself and thinks about things, to even the way a person eats and
sleeps. People with a depressive disorder cannot simply “pull themselves together”
and get better. A depressive disorder is not the same as a passing blue mood. Nor is it a
sign of personal weakness or a condition that can be willed or wished away. Without
treatment, symptoms can last for weeks, months or years.1
What causes depression?
According to the National Institute of Mental Health (NIMH), depressive disorders often
result from a combination of genetic, psychological and environmental factors. For
example, some types of depression run in families, suggesting a biological inheritance for
the illness. Research also indicates that physical changes in the body, from medical
illnesses such as stroke, heart attack and cancer, can cause depression. Whether
inherited or resulting from another cause, a major depressive disorder is often associated
with changes in brain structures or brain function.
What are the symptoms of depression?
Not everyone who has a depressive disorder experiences the same symptoms. Some
people experience a few symptoms, some many. In fact, the NIMH states that the number
and severity of symptoms varies with individuals and varies over time. But generally,
symptoms of depression include persistent sad or anxious moods; feelings of pessimism,
guilt or helplessness; loss of interest or pleasure in hobbies and activities, including sex;
decreased energy; difficulty concentrating and/or remembering; insomnia or over-
sleeping; change in appetite or overeating and/or change in weight or weight gain;
thoughts of death or suicide; suicide attempts.
How many people experience depression?
Approximately 19 million American adults ages 18 and older experience a depressive
disorder in any given year.2 Nearly twice as many women (about 12 percent) as men (6.6
percent) are affected by a depressive disorder each year.3
What is the economic impact of depression?
According to the World Health Organization, depression is the leading cause of disability
in the United States.4 Major depressive disorder costs the United States $80 billion in
direct and indirect costs, including medical expenses, days missed from work, lost
productivity and premature death.5 Annual depression treatment costs in the United
States exceed $30 billion, including $13.7 billion for drugs alone.6According to published
studies, patients with treatment-resistant depression (TRD) have more than six times the
average medical costs of patients who do not have treatment-resistant depression
($42,344 vs. $6,512).7 A person with depression is 35 times more likely to commit suicide
than a person without depression8 and 15 percent of patients who have been
hospitalized for depression commit suicide.9
What are the different types of depression?
Similar to medical illnesses like heart disease and cancer, depression comes in many
different forms. However, the NIMH identifies three common types of depressive disorders.
A diagnosis of major depressive disorder (MDD) is a combination of symptoms (as
described earlier) that interfere with the ability to work, study, sleep, eat and enjoy once
pleasurable activities. Such an episode of depression may last over two years (chronic
depression), may occur only once, or may occur several times in a lifetime (recurrent
depression). Twenty percent of patients who experience one episode of depression have
chronic depression that lasts at least two years.10
Dysthymia is a less severe type of depression that involves long-term, chronic symptoms
that do not disable, but keep one from functioning well or feeling good. Many people with
dysthymia also have major depressive episodes at some point in their lives. Dysthymia
affects approximately 10.9 million Americans over the age of 18.11
Another type of depression is manic-depressive illness, also called bipolar disorder. Less
prevalent than other forms of depressive disorders, manic-depression is characterized by
cycling mood changes: severe highs (mania) and lows (depression). Sometimes the
mood switches are dramatic and rapid, but most often they are gradual. Bipolar disorder
affects approximately 2.3 million American adults.12
Do all patients with depression seek treatment?
The NIMH reports that many people with a depressive disorder do not seek treatment.
The reasons for this are, in part, that many people perceive depression as an
untreatable illness and sometimes the effects of depression are not understood to be
symptoms of the illness.
What are the current treatment options available for depression?
There are a variety of antidepressant treatments available to treat a personÂ’s
depressive disorder including medications and psychotherapy. Some people with milder
depressive disorders respond to psychotherapy. Others with more moderate to severe
depression often benefit from antidepressant medications. Some studies have
demonstrated that a combination of psychotherapy and antidepressant medication may
be effective in some patients.
An additional treatment option is electroconvulsive therapy (ECT). ECT is the application
of an electrical current through electrodes applied to the patientÂ’s head to induce a
seizure. ECT is performed under anesthesia, and the amount of electricity needed to
induce a seizure varies considerably from patient to patient. The treatments are repeated
two or three times per week until clinical improvements are achieved. Typical courses of
ECT are six to ten treatments. Although this treatment has been shown to be a very
effective treatment for major depression in the short-term,13 relapse rates are very high.
14
What are the side effects of these treatments?
The most frequently reported side effects of antidepressant medications include: weight
gain, sexual dysfunction, dizziness, dry mouth, blurred vision, constipation and urinary
hesitation.
With ECT, memory impairment15 of varying severity is common and is by far the most
bothersome and frequently reported side effect.16
What is treatment-resistant depression?
While definitions of treatment-resistant depression (TRD) may differ, most psychiatrists
agree that TRD is a major depressive episode that has not had an adequate response to
at least two different classes of antidepressants at appropriate dose and duration.
Response is defined as at least a 50 percent reduction in the Hamilton Rating Scale for
Depression (HAM-D) scores. Response is a partial improvement in symptoms rather than
a state of being completely symptom-free. Generally, physicians continue to switch
medications and/or add psychotherapy or add augmentation agents. Augmentation
agents are drugs that are not generally considered to have significant antidepressant
activity when administered alone, but can enhance effectiveness of an antidepressant
drug when used in combination. Additional options for TRD are monoamine oxidase
inhibitors (MAOIs) and ECT. Many treatments used for depressions that do not respond,
or partially respond to the first or second attempt at antidepressant therapy, are poorly
tolerated by the patient and/or are associated with significant toxicity.
How many patients have treatment-resistant depression?
Twenty percent of Americans with depression or approximately 4 million people
experience TRD. People with TRD frequently visit the emergency room and are
hospitalized. Studies show that annual healthcare costs for patients with TRD exceed
$40,000 per patient per year.17
Are recurring episodes of depression common?
The risk of recurrence increases over time. More than 40 percent of patients experience
a recurrence after two years and more than 60 percent experience a recurrence after five
years.18
Are there any long-term treatment options for treatment-resistant depression?
Vagus Nerve Stimulation Therapy (VNS Therapy) is the first long-term treatment
specifically indicated for treatment-resistant depression and the first therapy specifically
studied and approved for chronic or recurrent treatment-resistant depression.
1 Strock M. Depression, 2002; National Institute of Mental Health, Pub. No. 02-3561. 2
National Institute of Health Pub. No. 01-4584 3 National Institute of Health Pub. No. 01-
4584 4 Murray CJL, Lopez AD. “Evidence-based health policy lessons from the Global
Burden of Disease Study,” Science. 1996;274: 740-743 5 Greenberg PE et al. “The
economic burden of depression in the United States: how did it change between 1990
and 2000?,” Journal of Clinical Psychiatry.64(12):1465, December 2003: 75 6 IMS Data;
Journal of Clinical Psychiatry 2002, Nov;63(11) 7 Crown W. “The Impact of Treatment-
Resistant Depression on Health Care Utilization and Costs,” J. Clin Psychiatry. 63:11,
Nov. 2002. 8 “Melancholy Nation”, U.S. News and World Report. March 8, 1999, pages
56-63. 9 Nordenberg L. “Dealing with the Depths of Depression,” FDA Consumer
Magazine. July-August 1998. 10 Keller MB, Boland RJ. Biological Psychiatry. 1998;44(5):
348-360 11 National Institute of Health Pub. No. 02-3561 12 National Institute of Health
Pub. No. 02-3561 13 Fink M, “When to consider ECT Algorithm seeks respect for
neglected therapy,” Current Psychiatry. 2003;2(8):49-56 14Sackeim HA et al. Â
“Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive
Therapy,” JAMA. 2001;285:1299-1307. 15 Fink M, Bailine S. “Electroconvulsive
therapy and managed care,” Am J Managed Care 16Zajecka JM. “Clinical issues in
long-term treatment with antidepressants,” J. Clin Psychiatry 17 Crown W. “The Impact
of Treatment-Resistant Depression on Health Care Utilization and Costs,” J. Clin
Psychiatry. 63:11, Nov. 2002. 18 Keller MB, Boland RJ. Biological Psychiatry: 1998;44(5):
348-360
ACKNOWLEGEMENT
Cyberonics, Inc., provides information for the above article.
To obtain more information about vagus nerve stimulator: 1-877-NOW-4-VNS or visit www.
VNSTherapy.com.
HOME
THIS ARTICLE IS FOR YOUR INFORMATION ONLY. IF YOU HAVE ANY QUESTION,
PLEASE, CONSULT WITH YOUR DOCTOR IMMEDIATELY.
ALL RIGHT RESERVED.
Antidepressant medication There are four classes of antidepressants: Tricyclic
Antidepressants (TCAs); Monoamine Oxidase Inhibitors (MAOIs); Selective Serotonin
Reuptake Inhibitors (SSRIs) and “atypical antidepressants” which include other
mechanisms of action.
Anxiety disorders: Anxiety disorders are a group of emotional illnesses including phobias,
panic attacks, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD)
and post-traumatic stress disorder.
Bipolar disorder: Commonly known as manic depressive illness, bipolar disorder involves
mood swings from “high” episodes of mania to periods of depression. Between
episodes, the people with bipolar disorder often experience the normal range of moods.
Manic episodes are distinguished by feelings of euphoric happiness, irritability and high
levels of energy.
Cingulotomy: A surgical technique that interrupts the cingulate gyrus, a bundle of nerve
fibers in the front of the brain, by applying heat or cold. This procedure has been used to
treat obsessive compulsive disorder.
Clinical depression: Emotional experiences of sadness, loss or mood states that are
persistent and can interfere significantly with an individualÂ’s ability to function.
Cognitive behavioral therapy (CBT): According to proponents of this psychotherapy
approach, how you feel is the result of how you think. Cognitive therapists help patients
identify distorted or negative ways of thinking and replace them with more positive
perceptions. Depression is relieved by altering an unrealistically negative view of ones
self and the world. People with major depression or anxiety disorders may benefit most
from CBT according to The Journal of Rational-Emotive & Cognitive-Behavior Therapy.
Chronic or recurrent depression: A major depressive episode that is of at least two years
in duration is called chronic depression. When multiple depressive episodes occur over
time, this is called recurrent depression.
Dysthymic disorder (formerly known as dysthymia): A long lasting, persistent, mild
depression lasting at least two years, often accompanied by major depressive episodes.
Electroconvulsive therapy (ECT): A treatment usually for the symptoms of severe and/or
psychotic depression, ECT is the application of an electrical current through electrodes
applied to the patientÂ’s head to induce a seizure. ECT is performed under anesthesia
and the amount of electricity needed to induce a seizure varies considerably from patient
to patient. The treatments are repeated two or three times per week until clinical
improvements are achieved. Typical courses of ECT are six to ten treatments. Relapse
rates are high, and many patients experience memory impairment.
Failed adequate treatment: Failure to respond to electroconvulsive therapy or an
established antidepressant drug administered at an adequate dose for an adequate
duration.
Interpersonal therapy (IPT): Short-term therapy that concentrates on relationships as the
key to understanding and overcoming emotional difficulties. The overall goal of IPT is to
relieve symptoms of depression, improve self-esteem and help patients get what they
want or need from relationships in a positive way. The bond that the client develops with
the therapist is a crucial component of this therapy.
Major depression: A severe form of depression characterized by having five or more
symptoms of depression (as defined by DSM IV) during the same two week period.
Symptoms include intense sadness, feelings of hopelessness, a sudden change in
appetite or weight and a loss of pleasure and interest in normal activities.
Major depressive disorder: Mood disorder characterized by one or more episodes of
major depression.
Major depressive episode: Meets the criteria for being in a current episode of major
depression.
Mania: An acute mood characterized by euphoria, a sense of well-being and an increase
in activity level. One of the two mood cycles experienced in bipolar disorder.
Manic Depression or manic depressive illness: See Bipolar Disorder
Neurotransmitters: Chemicals used by brain cells to communicate.
Psychiatrists: Licensed medical doctors who specialize in diagnosing and treating mental
illness. They provide counseling and can prescribe medications.
Psychologists: Psychologists may have a Ph.D. in psychology or a Psy.D. (doctorate in
clinical psychology). However, they do not study medicine and cannot prescribe
medication.
Psychotherapy: The treatment of emotional or mental disorders by counseling. Most
mental health professionals tailor their approach to the needs, problems and personality
of the person seeking help, and they may combine different techniques in the course of
therapy. Many individuals are turning to short-term psychotherapy which may last several
weeks to several months. Most likely to benefit are those interested in solving an
immediate problem.
Remission: Remission is defined as the absence of depressive symptoms and the return
of psychosocial functioning for at least six months. Patients with depression who achieve
remission no longer meet the criteria for major depression.
Response: Response is defined as at least a 50 percent reduction in the Hamilton Rating
Scale for Depression (HAM-D) scores. Response may be a partial improvement in
symptoms rather than a state of being completely symptom-free.
Selective Serotonin Reuptake Inhibitors (SSRIs): Medications, such as fluoxetine
(Prozac), sertaline (Zoloft) and paroxetine (Paxil), which alter brain chemistry and relieve
depressive symptoms by affecting the neurotransmitter serotonin. These drugs can be
used in conjunction with psychotherapy or as the primary treatment.
Treatment-resistant depression (TRD): While definitions of treatment-resistant
depression may differ, most psychiatrists agree that treatment-resistant depression is a
major depressive episode that has not had an adequate response to at least two classes
of adequate antidepressants at appropriate dose and duration. At least 20 percent of all
patients with major depression may experience treatment-resistant depression.
Unipolar major depression: A person who has five or more depression symptoms (as
defined by DSM IV) and experiences impairment in usual functioning nearly every day
during the same two-week period. It typically occurs in discrete episodes that happen
over a personÂ’s lifetime.
Vagus nerve: The tenth cranial nerve. A mixed nerve that has both motor and sensory
function.
Vagus Nerve Stimulation (VNSÔ) Therapy System: VNS Therapy is approved for the
adjunctive long-term treatment of chronic or recurrent depression for patients 18 years of
age or older who are experiencing a major depressive episode and have not had an
adequate response to four or more adequate antidepressant treatments. VNS Therapy
consists of an implanted pacemaker-like device that delivers mild, intermittent pulses that
are sent to the vagus nerve, which then modulates activity in various areas of the brain
thought to be involved in mood regulation. The VNS Therapy System is at various levels
of investigational clinical study as a potential treatment for anxiety disorders, AlzheimerÂ’s
disease, chronic headache/migraine and bulimia.
Frequently Asked Questions About Depression
What is depression?
Depression, or depressive disorder, is a serious illness that involves the body, mood and
thoughts. Depression may affect many aspects of a personÂ’s life: from the way a person
feels about him or herself and thinks about things, to even the way a person eats and
sleeps. People with a depressive disorder cannot simply “pull themselves together”
and get better. A depressive disorder is not the same as a passing blue mood. Nor is it a
sign of personal weakness or a condition that can be willed or wished away. Without
treatment, symptoms can last for weeks, months or years.1
What causes depression?
According to the National Institute of Mental Health (NIMH), depressive disorders often
result from a combination of genetic, psychological and environmental factors. For
example, some types of depression run in families, suggesting a biological inheritance for
the illness. Research also indicates that physical changes in the body, from medical
illnesses such as stroke, heart attack and cancer, can cause depression. Whether
inherited or resulting from another cause, a major depressive disorder is often associated
with changes in brain structures or brain function.
What are the symptoms of depression?
Not everyone who has a depressive disorder experiences the same symptoms. Some
people experience a few symptoms, some many. In fact, the NIMH states that the number
and severity of symptoms varies with individuals and varies over time. But generally,
symptoms of depression include persistent sad or anxious moods; feelings of pessimism,
guilt or helplessness; loss of interest or pleasure in hobbies and activities, including sex;
decreased energy; difficulty concentrating and/or remembering; insomnia or over-
sleeping; change in appetite or overeating and/or change in weight or weight gain;
thoughts of death or suicide; suicide attempts.
How many people experience depression?
Approximately 19 million American adults ages 18 and older experience a depressive
disorder in any given year.2 Nearly twice as many women (about 12 percent) as men (6.6
percent) are affected by a depressive disorder each year.3
What is the economic impact of depression?
According to the World Health Organization, depression is the leading cause of disability
in the United States.4 Major depressive disorder costs the United States $80 billion in
direct and indirect costs, including medical expenses, days missed from work, lost
productivity and premature death.5 Annual depression treatment costs in the United
States exceed $30 billion, including $13.7 billion for drugs alone.6According to published
studies, patients with treatment-resistant depression (TRD) have more than six times the
average medical costs of patients who do not have treatment-resistant depression
($42,344 vs. $6,512).7 A person with depression is 35 times more likely to commit suicide
than a person without depression8 and 15 percent of patients who have been
hospitalized for depression commit suicide.9
What are the different types of depression?
Similar to medical illnesses like heart disease and cancer, depression comes in many
different forms. However, the NIMH identifies three common types of depressive disorders.
A diagnosis of major depressive disorder (MDD) is a combination of symptoms (as
described earlier) that interfere with the ability to work, study, sleep, eat and enjoy once
pleasurable activities. Such an episode of depression may last over two years (chronic
depression), may occur only once, or may occur several times in a lifetime (recurrent
depression). Twenty percent of patients who experience one episode of depression have
chronic depression that lasts at least two years.10
Dysthymia is a less severe type of depression that involves long-term, chronic symptoms
that do not disable, but keep one from functioning well or feeling good. Many people with
dysthymia also have major depressive episodes at some point in their lives. Dysthymia
affects approximately 10.9 million Americans over the age of 18.11
Another type of depression is manic-depressive illness, also called bipolar disorder. Less
prevalent than other forms of depressive disorders, manic-depression is characterized by
cycling mood changes: severe highs (mania) and lows (depression). Sometimes the
mood switches are dramatic and rapid, but most often they are gradual. Bipolar disorder
affects approximately 2.3 million American adults.12
Do all patients with depression seek treatment?
The NIMH reports that many people with a depressive disorder do not seek treatment.
The reasons for this are, in part, that many people perceive depression as an
untreatable illness and sometimes the effects of depression are not understood to be
symptoms of the illness.
What are the current treatment options available for depression?
There are a variety of antidepressant treatments available to treat a personÂ’s
depressive disorder including medications and psychotherapy. Some people with milder
depressive disorders respond to psychotherapy. Others with more moderate to severe
depression often benefit from antidepressant medications. Some studies have
demonstrated that a combination of psychotherapy and antidepressant medication may
be effective in some patients.
An additional treatment option is electroconvulsive therapy (ECT). ECT is the application
of an electrical current through electrodes applied to the patientÂ’s head to induce a
seizure. ECT is performed under anesthesia, and the amount of electricity needed to
induce a seizure varies considerably from patient to patient. The treatments are repeated
two or three times per week until clinical improvements are achieved. Typical courses of
ECT are six to ten treatments. Although this treatment has been shown to be a very
effective treatment for major depression in the short-term,13 relapse rates are very high.
14
What are the side effects of these treatments?
The most frequently reported side effects of antidepressant medications include: weight
gain, sexual dysfunction, dizziness, dry mouth, blurred vision, constipation and urinary
hesitation.
With ECT, memory impairment15 of varying severity is common and is by far the most
bothersome and frequently reported side effect.16
What is treatment-resistant depression?
While definitions of treatment-resistant depression (TRD) may differ, most psychiatrists
agree that TRD is a major depressive episode that has not had an adequate response to
at least two different classes of antidepressants at appropriate dose and duration.
Response is defined as at least a 50 percent reduction in the Hamilton Rating Scale for
Depression (HAM-D) scores. Response is a partial improvement in symptoms rather than
a state of being completely symptom-free. Generally, physicians continue to switch
medications and/or add psychotherapy or add augmentation agents. Augmentation
agents are drugs that are not generally considered to have significant antidepressant
activity when administered alone, but can enhance effectiveness of an antidepressant
drug when used in combination. Additional options for TRD are monoamine oxidase
inhibitors (MAOIs) and ECT. Many treatments used for depressions that do not respond,
or partially respond to the first or second attempt at antidepressant therapy, are poorly
tolerated by the patient and/or are associated with significant toxicity.
How many patients have treatment-resistant depression?
Twenty percent of Americans with depression or approximately 4 million people
experience TRD. People with TRD frequently visit the emergency room and are
hospitalized. Studies show that annual healthcare costs for patients with TRD exceed
$40,000 per patient per year.17
Are recurring episodes of depression common?
The risk of recurrence increases over time. More than 40 percent of patients experience
a recurrence after two years and more than 60 percent experience a recurrence after five
years.18
Are there any long-term treatment options for treatment-resistant depression?
Vagus Nerve Stimulation Therapy (VNS Therapy) is the first long-term treatment
specifically indicated for treatment-resistant depression and the first therapy specifically
studied and approved for chronic or recurrent treatment-resistant depression.
1 Strock M. Depression, 2002; National Institute of Mental Health, Pub. No. 02-3561. 2
National Institute of Health Pub. No. 01-4584 3 National Institute of Health Pub. No. 01-
4584 4 Murray CJL, Lopez AD. “Evidence-based health policy lessons from the Global
Burden of Disease Study,” Science. 1996;274: 740-743 5 Greenberg PE et al. “The
economic burden of depression in the United States: how did it change between 1990
and 2000?,” Journal of Clinical Psychiatry.64(12):1465, December 2003: 75 6 IMS Data;
Journal of Clinical Psychiatry 2002, Nov;63(11) 7 Crown W. “The Impact of Treatment-
Resistant Depression on Health Care Utilization and Costs,” J. Clin Psychiatry. 63:11,
Nov. 2002. 8 “Melancholy Nation”, U.S. News and World Report. March 8, 1999, pages
56-63. 9 Nordenberg L. “Dealing with the Depths of Depression,” FDA Consumer
Magazine. July-August 1998. 10 Keller MB, Boland RJ. Biological Psychiatry. 1998;44(5):
348-360 11 National Institute of Health Pub. No. 02-3561 12 National Institute of Health
Pub. No. 02-3561 13 Fink M, “When to consider ECT Algorithm seeks respect for
neglected therapy,” Current Psychiatry. 2003;2(8):49-56 14Sackeim HA et al. Â
“Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive
Therapy,” JAMA. 2001;285:1299-1307. 15 Fink M, Bailine S. “Electroconvulsive
therapy and managed care,” Am J Managed Care 16Zajecka JM. “Clinical issues in
long-term treatment with antidepressants,” J. Clin Psychiatry 17 Crown W. “The Impact
of Treatment-Resistant Depression on Health Care Utilization and Costs,” J. Clin
Psychiatry. 63:11, Nov. 2002. 18 Keller MB, Boland RJ. Biological Psychiatry: 1998;44(5):
348-360
ACKNOWLEGEMENT
Cyberonics, Inc., provides information for the above article.
To obtain more information about vagus nerve stimulator: 1-877-NOW-4-VNS or visit www.
VNSTherapy.com.
HOME
THIS ARTICLE IS FOR YOUR INFORMATION ONLY. IF YOU HAVE ANY QUESTION,
PLEASE, CONSULT WITH YOUR DOCTOR IMMEDIATELY.
ALL RIGHT RESERVED.
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