Another chance
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No Comments [ Add Comment ]By Jamie Lampros
Standard-Examiner correspondent
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strong>New procedure 'a lifesaver' for severely depressed man
OGDEN - When Sean Kearney was in the fifth grade, he made an announcement to his friends.
"I told them to stay away from me," he said. "I told them I didn't want to be friends anymore and to leave me alone. I was not nice at all."
Kearney managed to make more friends in junior high school, but those friendships didn't last.
"I walked to a track meet with three close friends and I walked home without any friends at all," Kearney said. "I didn't understand all of the angry emotions I had inside of me."
Kearney didn't know it at the time, but he can see now that his behavior was the beginning of what he calls a life of hell.
Kearney, now 39, has been diagnosed with bipolar I, the most severe form of manic-depression.
After numerous failed treatments, he is finally finding some relief from an implanted device called a vagus nerve stimulator. Before the device came on the market and was approved for depression, Kearney said, his life was fairly hopeless.
What started out as alienating his friends turned into bouts of high energy, followed by bouts of deep depression. The cycles were vicious and unrelenting. Kearney, who went on to be a professional artist, would be very productive one day and then sleep for two weeks.
His family would have to wake him up and force him to eat. He even planned his suicide at one point.
"I was going to asphyxiate myself," he said. "I set everything up in the garage. I went and looked at my wife while she was sleeping and then I went out and sat down on the couch and accidentally fell asleep. I didn't understand why I was this way. There's no reason for it. I had the best job in the world and everything going for me."
Nothing worked
Kearney's first major manic episode came in 1989, after his first son was born.
"After that, it was back and forth from one project to another. His moods went up and down very often," said Sean's wife, Jeri. "It was such a vicious cycle."
In 1993, Sean had more and more depressed episodes and even began cutting himself, Jeri said.
"The self-mutilation got worse by 1995. He was extremely depressed, had suicidal thoughts and was isolating himself from society," Jeri said. "He was hospitalized several times for severe depression, and doctors told him he was medication-intolerant."
In 1995, he received an official diagnosis. His family doctor, South Ogden IHC physician Brent Williams, referred him to a psychiatrist.
"It was clear to me within a short time that Sean had some very complicated psychiatric issues," Williams said. "As a family physician, I see a lot of depression, but Sean's was one of the worst cases I had encountered."
Kearney was sent to Richard Charlat, a psychiatrist at McKay-Dee Behavioral Institute. Charlat tried several medications for Sean's condition, but nothing seemed to help.
Then he suggested electroconvulsive therapy, a procedure that produces a seizure with an electric current and is used for the relief of depressive symptoms that do not respond to other forms of treatment
"ECT has a very high probability for success, although we aren't sure exactly how it works. However, because of the side effects, you literally try to move heaven and earth before you put someone through ECT," Charlat said.
The ECT treatment was done every two weeks for two years. Kearney said the sessions provided little relief and left him with side effects that included severe headaches and memory loss.
"I can't remember getting married and I have no memory of my two sons' childhood years," he said. "I was taking up to 45 Lortabs a day to try to ease the headaches."
The worst kind
Charlat said there are varying degrees of bipolar disorder, and Kearney has the worst form. Bipolar I, he said, is characterized by episodes of mania, but more often depression.
Charlat said Kearney would experience racing thoughts and high energy, along with the loss of need for sleep. He was hypertalkative and would lift weights until 3 in the morning.
That was followed by delusions, irrational thoughts, major depression, sleeping too much and panic attacks.
"Sean has a family history of depression with a tragic ending to the death of his brother by suicide in 2000," Charlat said. "The risk, as far as Sean was concerned, was through the roof. He had some serious plans to harm himself. He was on a long list of medications, from antidepressants to mood stabilizers to medications to keep him awake and medications to help him sleep. Nothing was helping this young man."
VNS introduced
The vagus nerve stimulator was first introduced as a treatment for epilepsy, said Navin Varma, a South Ogden neurologist. The stimulator was approved in 2005 for the treatment of depression.
"It seems to be effective and easy," Varma said. "The data on depression is remarkable in that it is tested on patients that are refractory to other treatments. In this population with such profound depression, the VNS is effective much of the time. The side effects are minimal. This is a significant advance, in my opinion."
Vagus nerve stimulation involves an implanted pacemaker-like device that delivers mild, intermittently pulsed signals to the patient's left vagus nerve into the brain, according to Cyberonics, Inc., the maker of the device.
During clinical studies using the device, more than 50 percent of patients with chronic or recurrent treatment-resistant depression experienced at least a meaningful clinical benefit, and approximately one-third experienced at least 50 percent improvement in symptoms.
"There was no hesitation on our part," Jeri said. "Sean wanted this done and done now."
'Success story'
On Dec. 8, 2005, Sean had the device implanted by McKay-Dee Hospital cardiothoracic surgeon Michael Buch.
"No one knows the exact mechanism of how the VNS works," Buch said. "The theory is that afferent fibers from the vagus nerve going to the brain are stimulated and modify the brain in such a way as to reduce seizure activity from partial-onset seizures and certain cases of intractable depression."
Buch said exactly which areas of the brain and how they are stimulated and responsible for the beneficial response is still the subject of research.
During the procedure, Buch said, the wire lead is placed on the left vagus nerve in the neck and is tunneled to a pocket below the left collar bone where it is connected to the generator. The shape, size and location of the pocket is exactly the same as a pacemaker for the heart.
A battery and electronics are in a single sealed unit, which has to be changed once the battery reaches the end of its life, which is approximately five to 10 years, Buch said.
Side effects include hoarseness, sore throat, shortness of breath and coughing. Results take from six months to one year.
"It's really helping," Charlat said. "I think Sean is doing remarkably well considering his family history. He's really a terrific guy. So often you see creative and intellectual people suffer from depression. These are wonderful people and it's worth all of our attention to help stabilize them because they are so productive in our society. In my opinion, Sean is a success story."
Sean said he's also noticing a difference.
"It's a lifesaver, literally," he said. "If I had to give it up right now, I would have no reason to get up in the morning. It's made me feel like waking up. Without it, I don't think I would have lasted. Now I don't want to die. I feel like life is worth living and I haven't felt that way in 12 years."
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