Touching the Right Nerve

After twenty years of therapy, antidepressants and hospitalization, Kathy Forant decided to try one last thing to ease her severe depression: a new nerve-stimulation treatment pioneered at Butler Hospital.

After twenty years of therapy, antidepressants and hospitalization, Kathy Forant decided to try one last thing to ease her severe depression: a new nerve-stimulation treatment pioneered at Butler Hospital.

Patient: Kathy Forant, 63, Pawtucket. Bill Forant, Kathy’s husband.
Doctor: Linda Carpenter, Chief of Butler Hospital’s Mood Disorders Program.

Kathy: For the last twenty years, I’ve averaged two to three hospital stays a year for my depression. It was that bad. Depression is lack. Lack of interest in all good things. Lack of energy and enthusiasm. It set in when my kids were teenagers. I felt like I wasn’t doing a good job as a mother. Many days I just couldn’t get out of bed. I wouldn’t get dressed or do things to care for myself like take a shower. I’ve even tried suicide. Though I’ve taken a bunch of different medications and even did electroconvulsive therapy (ECT), nothing helped much in the long-term.

Carpenter: Statistics show that about one in five people treated for depression will still not experience remission after trying several different antidepressant treatments, including medication, talk therapy and ECT. Butler was one of the sites that participated in clinical trials that led to the FDA’s 2005 approval of vagus nerve stimulation (VNS) for treatment-resistant depression. Here’s how it works: We implant a small, pacemaker-like device into the patient’s left chest area. A thin wire runs from it under the skin to the left vagus nerve in the neck, sending pulsed signals to the nerve, which activate areas of the brain responsible for transmission of neurotransmitters that affect mood, such as serotonin and norepinephrine.

Kathy: A friend gave me an article on VNS. I talked about it with my psychiatrist at the time. He told me to check it out, but I got the feeling he didn’t believe in it. I’d been in and out of every hospital in Rhode Island, so I was willing to try anything. My husband of forty-three years has been a saint putting up with me, but I was sick of being a burden on my family. I called Butler and they connected me with Dr. Carpenter.

Carpenter: I met Kathy in November of 2005. She was one of the first patients who came to me requesting the treatment. Not everyone is a good candidate for this, but she was. Kathy was in good health so she could undergo a surgery. She had tried several other treatments and had improved a bit after the ECT, so I knew she was capable of getting better. And she had reasonable expectations: She hoped the treatment would just keep her out of the hospital. It’s important to remember that this isn’t a snap, super treatment. It often takes a period of months, maybe even a year or two before patients get better.

Kathy: In January of 2006 I had an outpatient surgery at Rhode Island Hospital. I went to the hospital in the morning and was home by 5 o’clock. The recovery wasn’t too bad. The main problem was that my throat was sore, and I had a hard time speaking for a couple of days. 

Carpenter: We waited two weeks for the incision to heal and then turned on the device. There are several parameters to the dose, from intensity of the stimulus, frequency and width of pulse to how often they occur. In the beginning we started low so we could work up to the optimal dose. For the first couple of months I saw her for adjustments about once a month and then we tapered back to every few months, which is how often I see her now. Kathy’s device now turns on for thirty seconds and is off for 1.8 minutes. This doesn’t eliminate the need for meds. She still takes those in combination with this therapy.

Bill: I noticed a difference pretty quickly. She was more bubbly and alert. Before she would sit back and keep everything to herself, and she just couldn’t get motivated to do anything.

Kathy: I started really feeling better by the end of April. It was gradual — I didn’t wake up one day and say, ‘Wow I feel great.’ A new feeling of peace is the best way I can describe it. Slowly, I started having more energy and enthusiasm for life. My family said my facial expressions changed. I went back to things I’d lost interest in, like knitting and sewing. My relationship with Bill has always been strong, but now it’s like we’re in our honeymoon phase again.

Bill: She still has her off days, but it’s nothing like it used to be.

Carpenter: What’s particularly exciting is that research has found that one in three people who received VNS for a year experienced significant mood improvement, compared with only one in eight who only received other antidepressant treatment.

Kathy: I’m even going back to work. I haven’t worked in twenty years, but they just hired me at Jo-Ann Fabrics to teach a knitting class. Can you believe it? Before, I had such low self-esteem I’d never in a million years say I was good enough to teach.

—As told to Jenna Pelletier
Edited by O'Rya Hyde-Keller