Steve Collins is a 45-year-old unemployed architect who has been living with severe depression for 15 years. “I’m like a hermit crab hiding under rocks, crouching in dark spaces and only venturing out occasionally; there’s no light, no hope, no way in or out. I’ve been in therapy for years and must have taken at least six different antidepressant drugs. I had ECT (electroconvulsive therapy) and that literally shocked me out of it for a bit, but the depression came back – and the idea of ECT was so shocking for my family. People say: ‘Well, at least you haven’t got cancer.’ But, honestly, I’d rather have almost anything than live like this.”
A new type of treatment, vagal nerve stimulation (VNS), may offer hope for people like Collins who don’t improve with conventional depression treatment. A small battery-powered device like a pacemaker is inserted under the skin in the neck, from where it emits pulses of weak electical current to stimulate part of the vagus nerve. The vagus normally monitors our vital functions; it collects information about our breathing, heart rate and joint position, and sends signals back to the brain that tell it to respond if there are fluctuations.
Psychiatrist Umberto Albert, of the University of Turin, is also cautiously optimistic about VNS. “There is strong opposition to ECT in Italy, so we really don’t have anything to offer people with severe depression who have tried talking therapies and at least four antidepressant drugs. In the right patients, VNS can be effective, although they need to keep taking the drugs and be patient because it certainly takes six months until you see the effect.”