In her Grapevine home, this 57-year-old woman stumbles before an easy chair, before finally managing to take a seat. Those pills, she says, confound her equilibrium. That would be a small price to pay if only they'd work. These days, their way of ending her illness--she thinks it began in 1974 when she spiraled into pospartum depression following childbirth--is to numb her. "It hasn't stopped my depression," she says, "but made it livable...at least I don't spend time thinking how to kill myself."
More than a year ago, she had the VNS device implanted. She wishes she could say it's helped her depression, but all she can offer is a slim maybe. She says it probably has helped rid her of something else: the panic attacks that she says are worse than depression itself.
And for that single reason, she says of the device: "I'll never let them take it out."
She still worries, knows that she's becoming less independent, that one day her depression will win. Before its onslaught, she could handle life, the management of the businesses, the bowling alley, the casinos both here and abroad that she and her husband owned. That tough-minded person she once was, "that person is still inside," she says, her eyes teary, "but I can't do the things I used to." Each day, she sets a goal for herself. Today's: Vacuum before the reporter comes. Now divorced, living alone in a three-bedroom home, everything around her seems in place; antiques and intricate decor fill her home. The place seems tidy, but she says that's only because she barely moves. She knows, too. "It's dirty," she says, frowning. She often sits on the large easy chair, her television tuned to the TV Guide channel. By the time she's finished scrolling the list of programs, she's already forgotten what she's decided to watch, so the television remains on that station all day. That's her problem, she says: "CRS--Can't Remember Shit." She'll often lounge around for days on end in a nightgown. Today, though, she has managed to don makeup and a velvet shirt and pants. If she leaves her home, which is rare, it is to see her doctor, the one who recommended her for the VNS study.
Why some patients have responded better to VNS than others, no one can say for sure. "I can give you speculation," Rush says. "Depression probably has different biologies and a lot of different genetics, so it's not just one illness. We don't have one treatment that works for everybody."
For a man who's regarded as one of America's leading depression investigators, it's the closest he or anyone can come to a definitive answer.
Rush had once thought he'd be a mathematician, until the day, as a Princeton undergraduate, he was confronted with a problem he couldn't solve. When another classmate beat him to it, he knew that it was time to switch his major.
For the past three decades, Rush, an affable, unassuming man of 58, has tried answering a larger, vexing equation: the mystery of mental illness' roots.
But in all his years in psychiatry, he's never encountered what he did nearly two years ago, when he met the patients in the VNS pilot study. "They were the most poorly functioning set of outpatients with depression I've ever seen," he says. "This is not the happy-go-lucky characters that go to a psychotherapist to complain about their problems. They've been to hell and back with the treatments, and they're not well." Many couldn't hold down jobs. All were referred to the study by psychiatrists who'd exhausted all of their options.
When Rush began his career, there were only a handful of drugs, as well as psychotherapy and electroconvulsive therapy, available to patients. Now, the whole of neuroscience is massively different than it was even 10 years ago, as it's grown to include knowledge of neurotransmitters. Rush postulates that the VNS device may affect the production and activity of the neurotransmitter in the brain that is linked to depression. Studies so far have shown that VNS can change blood flow to certain parts of the brain that are known to be related to the illness.
The VNS surgery takes about two hours, and for about eight weeks, the electrical current stays the same. It is adjusted, if necessary, based on the patient's response. Once the device is set, the charge determined, it goes for years, until the battery runs out. To date, only one person in the pilot study has had the device removed, and the remainder continue to check in with doctors involved in the trial.