Guest speaker: John J Worthington, MD

Dr Worthington spoke about 45 minutes in one of the most informative presentations we've had in our 23-year history. He was our annual Mysteries of the Mind presenter w/a donation in his name going to the Peter C Alderman Foundation of Bedford, NY. In my letter to the foundation, I wrote:

At our support group, the leading Philadelphia group for people w/depression, bipolar disorder & their loved ones, we also know the meaning of mental anguish and the importance of alleviating it, which is why we have chosen your organization for our annual gift.

Here are some notes I took during his presentation. Thanks also to Murray, Mary and Mike (the 3 Ms?) who helped jog my memory.

In the beautiful Parish Hall of Abington Presbyterian Church, Dr. W sat on a chair and showed us the Vagus Nerve Stimulator, a small plastic device, that's implanted in the upper chest along with a wire which is attached to the vagus nerve near the carotid artery in the neck. Next he held up a "wand" that looked like a shower-head which is waved over the implant to start and program it.

Success rate at 6 months is 30 percent of the most resistant cases of depression. After 2 years, it rises to 50 percent. Not bad when considering these people have suffered for as long as 20 years and had no meaningful lives due to their illness.

Why is VNS used instead of ECT (electroconvulsive therapy)? Reasons include ineffectiveness of ECT plus ECT must be repeated on a regular basis.

Side effects of VNS are vitually nil.

VNS is done locally at University of PA by Dr. John O'Reardon. (He spoke at our group several yrs ago & is universally loved for his upbeat personality. Originally a family doctor from Ireland, he came to the US and became a psychiatrist, big into research).

ECT takes an average of 7 treatments for success. It's been greatly refined over the years. He didn't mention any side effects from ECT tho we have heard from our members who've received shock treatments that they encountered memory loss around the time they received treatment, in other words, short-term memory loss.

I asked a no. of questions including Is ECT safe for pregnant women? Dr. W said no studies have been done on this but did mention that the antidepressant Paxil has been shown to cause heart defects in the fetus. That man knows his stuff! We've had many pregnant women pass thru the doors of New Directions, all of whom have given birth to healthy babies (yes!), even while on meds.

Gianna writes a fascinating mental health blog and cited today (Sept. 18) a study by Bloomberg news admitting that Glaxo, the makers of Paxil, knew about the risk to the fetus. Click here.

One of Dr. W's patients is a woman who suffered from such terrible depression she lay down on the train tracks in Willow Grove PA to kill herself. She only lost a leg in the accident and finally came to the attention of Worthington. He convinced her, with the consent of her husband, to undergo VNS and it worked for her.

Unfortunately, Medicare denies coverage of VNS calling it "experimental" even tho they cover it for epilepsy. When Medicare denies coverage, insurance companies follow suit and also deny coverage. The woman's Aetna insurance was denied but Dr. Worthington called and spoke to Aetna's chief physician who "reversed himself" on his original denial.

The woman, who is an artist, continues to do freelance art work while working for her husband.

Depression is usually a recurring illness. With each recurrence, it raises the chance of having more depressions in the future.

When you first see a doctor, one-third of the patients will improve on the first medication that’s tried. After a number of drug trials, efficacy rate is 70 percent.

There’s a blood-brain barrier to protect the brain from toxic agents which is one reason antidepressants take so long to work: from 2 to 6 weeks.

Depression causes areas in the brain to atrophy. However cells in the brain are continually dying just as new cells are born. It’s important for the brain to "clean house" and sweep away the dead cells. In areas where cells have been killed by depression, neurogenesis or the birth of new brain cells can take place.

In other words, with depression the rate of cell death or apoptosis increases & neurogenesis is unable to replace the cells as quickly as they're lost. This could be an explanation for brain atrophy observed in depressed populations.

Imaging techniques have allowed researchers to probe the depths of the brain and discover the many areas that are affected by depression. Dr. W believes this physical evidence of depression will help alleviate stigma.

ECT changes the structure of nerve cells. It silences troublesome genes and turns on healthy genes.

Stress turns on alarm mechanisms which in healthy people are valuable flight or flight mechanisms but in the depressed or anxious person pumps too much cortisol into the brain which causes brain atrophy.

Worthington saw an 18-yo girl who had been nearly comatose w/depression since age 14. She had no expression on her face. She was tried on ECT which did nothing. Then she had VNS treatments, which she was deathly afraid of, but they worked so well she was able to participate in school and get a volunteer job.

Bipolar depression is harder to treat than unipolar.

Brilliant scientists are working hard in the field for all of us. Dr. W mentioned the work of Michael Meaney of McGill University and Helen Mayberg. Here's Meaney's profile. He speaks about the importance of good nurturing for babies and children for proper brain development. Interestingly, tho, even when a child is improperly nurtured, if they are removed from their mother & placed w/a nurturing mom, their brain can grow normally.

The neurologist Helen Mayberg was profiled here in a 2006 NY Times Magazine article.

When Worthington was finished, I gave him an ornamental pepper plant and said "I hope Mrs. Worthington likes gardening or maybe you can put it in your office." He's a good-looking man w/a full head of white hair and is probly in his early 70s.

I also told him I no longer suffered from bipolar disorder and he was delighted to hear it. I said I'd participated in a Bipolar genetic study at NIMH and the woman who interviewed me said they're finding that some people who've taken lithium are no longer symptomatic. He asked who was the head of the study.

Francis McMahon, I said.

Oh, he's good, said Dr. W. His name is cited in lots of studies I read.

I didn't tell Dr. W that McMahon, when last I spoke to him sev'l years ago, does not believe I'm cured.

You do get used to important people clinging to hard and fast ideas they learned in med school. Thankfully, not everyone is as closed-minded. I did write McMahon a note, however, enclosing our most recent Compass magazine, and telling him I am asymptomatic. Since his assistants are now acknowledging the truth about many of us being 'cured' from bipolar, I'd hope that McMahon will also see the light.