Brain Stimulation methods have been used successfully as effective treatment options for improving symptoms of chronic depression. They are usually recommended in patients who do not respond to other treatments.

A Vagus Nerve Stimulation is newly designed brain stimulation procedure where electrical impulses are sent into the patient’s brain for treating depression symptoms.

What is vagus nerve?

On each side of our body, a vagus nerve runs from brain through neck and chest to abdomen.

Indications for Vagus nerve stimulation

It is indicated as an added treatment for improving the symptoms of depression in patients who do not respond to following standard treatments.

  • Antidepressant medications
  • Psychological counselling (psychotherapy)
  • Electroconvulsive therapy (ECT)

Eligibility of vagus nerve stimulation

As per FDA guidelines, vagus nerve stimulation is performed in patients who satisfy below mentioned criteria.

  • Adults (age 18 or older)
  • Patients who have chronic and treatment-resistant depression
  • Patients who have not responded to antidepressant medications or electroconvulsive therapy (ECT)

Preparation for Vagus nerve stimulation

  • Your psychiatrist will perform complete physical examination before surgery.
  • You may be asked to conduct blood tests or other laboratory tests to ascertain that patient is medically fit for the procedure
  • Your doctor will prescribe antibiotics for preventing infection prior to the surgery
  • You should inform your doctor regarding any medications you are taking as you may be asked to stop or adjust the doses of certain medications before the surgery

Vagus Nerve Stimulation Procedure

During the vagus nerve stimulation, surgeon implants a device known as pulse generator in the chest of patient.  This pulse generator is connected to the left vagus nerve in patient’s neck through a wire threaded under the patient’s skin.

Doctors can monitor the activity of pulse generator and stimulates it to send out various electrical signals. These electrical signals are carried along the vagus nerve to the patient’s brain. It causes improvement in the symptoms of depression.

Risks of Vagus nerve stimulation

Although vagus nerve stimulation is a safe procedure, there are certain risks associated with surgery for implanting the device and during brain stimulation procedure.

Surgery risks

  • Pain at a point of incision
  • Infection
  • Heart problems
  • Incision scarring
  • Vocal cord paralysis
  • Breathing problems
  • Damage to the vagus nerve
  • Nausea

Side effects associated with vagus nerve stimulation

  • Chest pain
  • Cough
  • Throat pain
  • Voice changes
  • Breathing problems during exercise
  • Difficulty swallowing
  • Neck pain
  • Hoarseness
  • Prickling of the skin

Most of the side effects may improve over time, however certain side effects can be managed by adjusting the electrical impulses.

Other complications of vagus nerve stimulation

  • Pulse generator malfunction
  • Worsening of depression
  • Suicidal thoughts or behaviour

Results of Vagus nerve stimulation

  • In majority of the cases, depression symptoms will improve or diminish completely.
  • The optimal results are obtained after several months of treatment
  • Patient should continue to take antidepressant medication or attend psychotherapy sessions even after Vagus nerve stimulation.

Do not feel shame or humiliated if your manic depression requires you to be hospitalised. It is a completely normal procedure to spend few days in psychiatric ward for treating symptoms of severe depression.

In fact, if you feel that your symptoms are getting severe, you should consult your doctor and ask if you could be hospitalised.

Indications for Hospitalization

You may need to get hospitalised if you feel any of the following symptoms.

  • Suicidal tendency or thoughts
  • Psychotic symptoms like feeling paranoid or experiencing hallucinations
  • Thoughts of harming yourself or others
  • Inability to perform daily tasks such as bathing, dressing, etc
  • Inability to cope up with your conditions
  • Lack of support from family/friends
  • You need monitoring for side effects of your medications

Hospitalisation is not permanent

Many patients fear that they will be kept permanently at the hospital if their symptoms do not improve. However, it is a false notion. Patients are hospitalised only for few days so that their symptoms can be improved and they can be treated safely.

You should shun away any thoughts of shame or humility. Getting hospitalised for your mental conditions does not make you worthless individual. It is absolutely fine to get hospitalised and there is nothing wrong in getting treated in psychiatry ward.

There is a social stigma attached with depression or mental health disorders. Depression is not taken in the same way as other disease. If someone is experiencing life-threatening depression symptoms then there is no better place than hospital for the treatment.

Resident Treatment Program

If you are having severe depression symptoms your psychiatrist may advise you to get treatment at a residential treatment centre.

Rehabilitation centre is basically a live-in health care facility that provides treatment therapies for severe depression or other mental health disorders.

You can be sure of high quality medical care at rehabilitation centre. These resident treatment centres are located in the natural surroundings far away from pollution and noise of the cities.

Depressed patients are given various behavioural interventions at these centres that help in improving depression symptoms.

Questions to ask before selecting a resident treatment centre

  • What are various facilities offered at the facility?
  • What are the specific illnesses treated at the facility?
  • Does the facility provide dedicated nursing staff for every staff?
  • What are various treatment therapies provided at the facility?
  • Visiting hours to see the patient?
  • Frequency of visit of therapist or doctor to check the patient?
  • Duration of stay of the patient in the facility?
  • What are the personal items that patient should bring from home?
  • What are various discharge formalities?

Things to consider during discharge

  • Discuss the progress of patient during the stay
  • Ask for the present mental state of patient
  • Get the list of Do’s and Don’ts for the patient
  • Ask for any adjustments related to medications, food, etc for the patient
  • Get information about dosages, side effects of any medications prescribed to patient

You are what you think. Your thoughts have the power to make you happy even in worst of situations. Also, you may have everything and yet you can be sad if your thoughts are negative.

Psychiatrists use the power of thoughts to treat the symptoms of depression and other mental disorders in patients. This therapy which elevates the mood of the person by encouraging healthier ways of thinking is called as Cognitive Behavioural Therapy (CBT).

Cognitive Behavioural Therapy is being widely used as an effective treatment for depression. Patients are taught to recognize negative patterns of thought and eventually replace them with positive and happy thoughts.

CBT leads to changes in patient’s behaviour that stem from dysfunctional thinking. By making changes in pattern of thought and behaviour of patients, CBT aims to improve symptoms of depression.

Strategies of CBT

  • Socratic questioning
  • Role playing
  • Imagery
  • Guided discovery
  • Behavioural experiments

Indications of CBT

As per the researchers, CBT is as effective as antidepressants in treatment of mild and moderate cases of depression.

  • Individuals with mild or moderate depression can be treated by stand along CBT without even taking medication
  • Individuals with major depression are treated with combination of antidepressants and CBT
  • In adolescents who have mild and moderate depression
  • In patients who experience frequent relapses after treatment
  • In patients who are responding partially to medications for depression

Salient Features of Cognitive Behavioural Therapy (CBT)

  • CBT focuses on two primary tasks including Cognitive restructuring and Behavioural activation.
  • Cognitive restructuring involves one to one sessions between therapist and patient for changing thinking patterns
  • Behavioural activation that teaches patients to participate in pleasurable activities by overcoming negative thoughts
  • CBT is a time bound therapy that lasts for a time period of 14 to 16 weeks.
  • During CBT, psychiatrists try to analyse the pattern of patient’s thoughts with stress on what and how a person thinks at the moment rather than why a patient thinks that way.
  • The problems related to the patient’s behaviour and thinking are identified, prioritized, and analysed during CBT sessions. The specific problems of the patient are addressed in individual or group sessions.
  • The CBT sessions are goal oriented with short as well as long term goals are defined before the sessions. Some of the long term goals may take weeks to months to achieve.
  • CBT is found to be very effective in patients who are motivated and have ability for introspection
  • The therapist who conducts CBT, uses structured learning experiences for educating patients to monitor and ward off their negative thoughts. The patients learn to identify how negative thoughts affect their behaviour and physical condition.
  • CBT teaches the patients important coping skills for facing the stressful life events, solving their problems and scheduling pleasurable experiences.
  • During the CBT session, patients are encouraged to take active part in their learning.  They are also given homework assignments that are even graded and reviewed.

What is Pneumococcal Polysaccharide Vaccine (PPV23)?

The pneumococcal polysaccharide vaccine (PPV23) is the vaccine that provides protection against 23 serotypes of pneumococcal bacteria. After receiving the vaccine shot, healthy individuals develop protection against most of Pneumococcal strains within 2 to 3 weeks.

PPV23 can be administered along with other vaccines as it is an inactivated vaccine and one does not need to wait for receiving PPV23 after other vaccines are administered.

What is the need of PPV23?

Pneumococcal pneumonia is a killer disease that affects thousands of individuals every year across the world. In severe cases, it leads to life threatening conditions such as meningitis or bacteraemia.

It can affect anyone; however some individuals are more susceptible for getting infection such as 65 and older persons, infants and children, people with associated health conditions like heart or lung disease, HIV/AIDS, diabetes, etc.

Thus, prevention of Pneumococcal pneumonia with PPV23 vaccine drastically reduces the mortality rate associated with this dreaded disease.

Indications for vaccination with PPV23

Do you need a vaccination dose with PPV23? If you fall into any of the below mentioned categories, then you may visit your health care provider and discuss about receiving the vaccination dose.

                    Older Adults in age group of 65 years and above; need to get vaccinated if they are previously unvaccinated.

                    Individuals who smoke cigarettes should get vaccinated

                    Individuals (age between 2–64 years) with following conditions should get vaccinated

                    Chronic cardiovascular disease such as congestive heart failure, cardiomyopathy

                    Chronic pulmonary disease such as COPD, emphysema, asthma

                    Diabetes mellitus, cochlear implant patients

                    Chronic liver disease such as cirrhosis, alcoholic, or have a cerebrospinal fluid leak

                    Individuals who are residents of Alaska Natives or certain American Indian populations

                    Individuals between 2–64 years and have functional or anatomic Asplenia

                    Individuals (age 2 years and older) with immune-compromised system due to HIV/AIDS infection, Hodgkin’s disease, generalized malignancy, chronic renal failure, leukaemia, etc. 

                    Individuals who are receiving immune-suppressive therapy

                    Individuals who had receive an organ or bone marrow transplant

Do you need a second dose of PPSV?

If you had already received a dose of PPV23, you should check if you need a second dose of the PPV23 vaccine.

A second dose of PPV23 is indicated in the following conditions.

                    All children and adults (above 64 years) who are at greatest risk of life threatening pneumococcal disease 

                    All children and adults (above 64 years) who exhibit rapid decline in pneumococcal antibody levels

                    All adults (age 65 years and above) who were vaccinated with PPV23 before 65 years and there is gap of 5 years or more since the first dose.

Risks from PCV23

There is very minimal chance of any severe or life threatening medical problem due to vaccine.

The patient may experience following mild reactions.

 

                    Allergic reaction

                    Redness or tenderness in the region where shot was administered

                    Swelling in the region where shot was administered

                    Mild fever

 

What is the need of PCV 13?

The PCV 13 is used for the prevention of pneumococcal infections because the treatment of these infections is hard due to drug resistant strains of the bacteria. The Streptococcus pneumonia bacteria cause severe infection such as pneumonia and meningitis; especially in young children. 

The new pneumococcal conjugate vaccine (PCV13) provides protection from 13 strains of pneumococcal infections and found to be effective in preventing the occurrence of pneumonia in almost 80% of the cases among children under 5.

PCV13 is usually administered to the infants at high risk for serious diseases due to pneumococcal infections. The PCV13 can be given along with other vaccines.

Indications for PCV13

Infants and Children Under 2 Years of Age

PCV13 is administered as a series of 4 doses to infants and children under 2 years of age. The health care provider decides about the number of doses and length of intervals between them after considering the age of children.

It is also recommended for those children who had received PCV7 doses as they can complete their immunization series with PCV13.

Older Children and Adolescents

Children (age between 2 and 6 years) suffering from various medical conditions such as AIDS, Chronic lung or heart disease, sickle cell disease and others; should get 1 or 2 doses of PCV13 (doses to be determined by health care provider)

Healthy Children (age between 2 and 5 years) who had not received PCV7 or PCV13 before the age of 2 years.

Children and adolescents (age between 6 and 18 years) with certain medical conditions should be administered doses of PCV13 although they had received PCV7 or PPSV23 earlier.

Children who had received immunization series with PCV7

Healthy children less than 5 years can be given one dose of PCV13

Children with medical conditions (less than 6 years) can be given one dose of PCV13.

The doses should be given after recommendations from experienced health care provider.

Risks from PCV13

There is very minimal chance of any severe or life threatening medical problem due to vaccine. Even if severe allergic reactions are present, they will disappear within few hours after the vaccination procedure.

The patient may experience following mild reactions.

 

                    Allergic reaction

                    Drowsiness

                    Temporary loss of appetite

                    Redness or tenderness in the region where shot was administered

                    Swelling in the region where shot was administered

                    Mild fever

                    Fussy or irritable behaviour

The National Vaccine Injury Compensation Program (NVICP)

In 1986, a VICP program was brought into existence for providing compensation to those individuals who claim that they have been injured by a vaccine.

Individuals can file their claim with VICP through any of the following ways.

                    By calling 1-800-338-2382

                    By visiting the website at http://www.hrsa.gov/vaccinecompensation

Sources of information about PCV13

Individuals can get the further information about PCV13 from the following sources.

                    Health care provider

                    Vaccine package insert

                    By calling local or state health department

                    By contacting CDC office (Centers for Disease Control and Prevention)

                    By making calls at 1-800-232-4636 (1-800-CDC-INFO)

                    By visiting the CDC website at http://www.cdc.gov/vaccines

You would be amazed to learn that doctors remove a very small piece of lung for examination by performing lung needle biopsy. A lung needle biopsy is performed in severe complicated cases associated with lung and its tissues.

Doctors perform the biopsy after detecting the abnormalities on chest x-ray or CT scan.

The lung biopsy performed through the chest wall, is known as transthoracic lung biopsy.

Indications for Lung needle biopsy

                    Abnormal condition surrounding the lungs

                    Infections inside the lungs

                    Severe infection on the chest wall

                    To rule out the presence of cancer

Preparation for Lung needle biopsy

Patient should follow the below mentioned guidelines before lung needle biopsy procedure.

                    Patient is asked to not eat 6 – 12 hours prior to the procedure.

                    Patient should avoid certain medications like aspirin, NSAIDs or blood thinners, etc; few weeks before the procedure. However one should discuss with doctor before changing or adjusting the doses of these medications.

                    Doctors usually perform a chest x-ray or chest CT scan before the procedure.

                    Patient is administered with mild sedative for relaxation prior to biopsy.

                    Patient is asked to sign a consent form before the procedure.

                    Patient is asked to avoid coughing and remain as still as possible during the biopsy.

Lung needle biopsy Procedure

                    The exact spot for the biopsy is determined by using a chest x-ray or chest CT scan.

                    Patient is made to sit with his/her arms resting forward on a table. Patient is asked to avoid any coughing and remain still during the biopsy.

                    The small patch of the skin scrubbed and patient is asked to hold his/her breath. Doctor injects the local pain-killing medicine for numbing the area.

                    Doctor makes a small cut of about 0.12 inches into the skin and inserts the biopsy needle into the lung tissue. It is followed by removing a small piece of tissue with the needle.

                    The removed lung tissue is sent to laboratory for further examination. After the procedure, the bleeding is stopped by exerting pressure on the site.

                    Once the bleeding is stopped, a bandage is applied on the operated region. Patient is sent for chest X- ray immediately after the biopsy.

                    The time duration for the entire procedure vary from 30 – 60 minutes. The sample obtained from lung needle biopsy is sent for Lab analysis which takes few days to get completed.

Lung needle biopsy Results

The results of the lung needle biopsy are obtained after the analysis of obtained lung tissues is completed.

Normal Results indicate the presence of normal tissues and absence of any bacteria, viruses, or fungi.

Abnormal Results indicate the presence of following infections.

                    Bacterial or viral infection

                    Fungal lung infection

                    Cancerous cells

                    Pneumonia

Lung needle biopsy Risks

                    Occurrence of collapsed lung called as pneumothorax

                    Higher risk in case of certain lung diseases like emphysema

                    Air leakage from the lung that gets trapped in the chest

                    Risk of excessive bleeding (haemorrhage)