I am a psychiatrist in private practice in
Asheville, North Carolina. I trained in medical
school at Duke University, served 12 years in
the US Air Force as a psychiatrist, and have
been in private practice here now for nine
years. I treat a wide range of psychiatric
illness and see a particularly large number of
patients with chronic severe depression. For
the last four months I have been referring
select patients with particularly severe
treatment-resistant depression for surgery and
subsequent Vagus Nerve Stimulation (VNS)
therapy. So far I have had five patients
implanted with this device, all of whom have
Medicare as their primary insurance. Most of
these patients have had severely debilitating
symptoms. They have had marked depression for
three or four decades with virtually no relief
of symptoms. They have had recurrent
psychiatric hospitalizations, numerous ECT
treatments and an average of 10-15 trials of
antidepressant medication without sustained
effect. They carried a profound sense of
hopelessness and despair. All have either
attempted suicide or have had persistent and
strong suicidal thoughts. Even though it is
quite early in their treatment with Vagus Nerve
Stimulation, I have seen surprising and marked
response. One gentleman had 40 years of severe
disabling depression, had cut off all
relationships and been a virtual prisoner in his
own home for years. He had gone through
numerous medications, hospitalization and ECT
without success. After six solid years of
weekly psychotherapy with me and countless
failed medication trials I had virtually given
up hope of his recovery. One month after
activating his vagus nerve stimulator he was
brighter, more energetic, joined two separate
social groups, and began his first dating
relationship in decades. I was astounded at the
rapid improvement and am convinced VNS was the
major factor. My other patients have not had
quite as dramatic improvements, but all are
significantly better.
I have followed the medical literature on Vagus
Nerve Stimulation and have been increasingly
impressed by the results. Response rates to VNS
(defined as a 50% or greater reduction in the
Hamilton depression score) are as high as 44% at
one year of VNS treatment for patients with
severe treatment-resistant depression (Dr.
Nahas, Journal of Clinical Psychiatry; Sept
2005). These were severely depressed patients
with an average of 15 unsuccessful medication
trials for their current depressive episode. To
put this in perspective, similarly matched
patients with treatment-resistant depression
without Vagus Nerve Stimulation had a 13%
response rate at one year with standard
medication treatment (Biologic psychiatry;
September 2005). VNS thus appears to have more
than tripled the response rates for patients
with chronic severe depression. This is
particularly pertinent in these days of rising
health-care costs since the average medical
expense for patients with treatment-resistant
depression is $30-45,000 per year (Journal of
Clinical Psychiatry; May 2006). A treatment that
triples the response rate for treatment-
resistant depression will reduce psychiatric
hospitalization rates and this excessive yearly
health care cost of depression.
Chronic unrelenting depression is a horrible
illness to have. For those who do not respond
to medications, hospitalizations, or ECT their
lives can become living nightmares. They are
often without hope and one step away from
suicide. It is for these patients that Vagus
Nerve Stimulation therapy holds the most
promise. It has restored hope in these
patients’ lives where hope had vanished. I
would strongly urge you to consider the medical
data for vagus nerve stimulation as well as the
personal lives and stories of these patients
with unrelenting depression and allow them this
potential option for new life.

Thank you for your time.

Sincerely,

Steven Buser, MD
Psychiatrist