Commenter: armistead, md, c. a. 
Title: MD
Organization: LSU School of Medicine-Associate Professor of Psychiatry
Date: 08/15/2006
Comment:
As a practicing psychiatrist with over 40 years
of both clinical and academic experience I
strongly urge you to include medicare coverage
for vns for treatment resistant depression. I
have seen, over the years, many new treatments in
the form of pills. None since the discovery of
tricyclic antidepressants has truthfully been
novel. Certainly there has not been any progress
made toward the treatment of the toughest of the
tough patients strapped with life altering
depression. Even with the advent of Prozac and
its SSRI predessors, nothing new was brought to
the practice of psychiatry in the way of efficacy
and certainly not for treating trd. In my many
years both teaching and practicing I have
prescribed ethical pharmaceutical products and
ECT. Neither has been a long term option for my
patients. My insight about traditional treatments
are further endorsed by the recent release of the
NIMH sponsored STAR*D-implications for clinical
practice which concludes that current treatments
for the chronically depressed don't work and are
a tremendous burden to the taxpayer. I have had
2 VNS patients(I would have more if coverage was
currently available) and both had a remarkable
response very early on and have maintained that
response for almost a year. Both suffered from
debilitating illness which required the patients
to claim permanent disablilty. To my surprise,
one patient has obtained work at a lumber yard
and the other volunteers her time at the local
Goodwill store. Without VNS, I am convinced
neither would have occured. Please make this
treatment available for the millions of Americans
who are hopeless and suffer as non-productive
citizens each day. Anything less should be
considered discrimination and handled under the
Americans with Disabilities Act. Do the right
thing!
 

http://www.cms.hhs.gov/MCD/viewpubliccomments.asp?nca_id=195&expand=Y#0807200609062006A