I mentioned this in my last post as an option I want to consider, but I forgot to explain it. (As Dr. Mind would say "Talk human". It's hard to remember some of my vocabulary is technical).
A vagal nerve stimulator (VNS) originally was a treatment for seizures that is now used for treatment resistent depression as well. It is one of those things that you have to have failed everything else before insurance will think about it, and the chances of success are low unless you've reached the point you need it in which case they are reasonable.
My understanding is not 100%; it's an idea that we've discussed many times in the past but not lately. So some of this is what I think.
The device is similar to a pacemaker. It goes in the same place and is around the same size (maybe 2-3" diameter). They also make another incision that is allegedly invisible in the crease of your neck, and that allows wires to come into contact with the vagal nerve. The disc is then programmed to stimulate that nerve every so often, which in term stimulates something in the brain that is good. I'm unclear right now on how that part works.
For many years this was my doctor's main goal for me, to get me stable enough to have the thing implanted. Eventually I asked to not talk about it anymore because I knew that at that time I was getting worse over time and a goal that was seemingly impossible. By then time passed and the right mood stabilizer came out and I was doing so well it never came up because I didn't need it. I wasn't at my last option anymore.
At this point though I want to talk about it again. The fact is that from now on, as long as I'm on the MAOIs, which is likely to be long-term since nothing works in the other categories, there is a constant risk of hospitalization. Any change, even to an oral MAOI (possibly excepting the oral version of my patch?) would mean 2 weeks of no antidepressant at all. Since 2 days of that turned into extremely suicidal and miserable moods that would mean 2 weeks inpatient to get off, then time to get started, meaning a potential 3 week stay. I know people can manage the wash-out period, but I can't. And 3 weeks in a psych unit is unbearable sounding. It wasn't that bad, but it wasn't home. There's also just things that are tricky with the MAOI. I don't care about the foods, and after years of lithium the drug interactions are no big deal, but it does scare me that I'd need to be off for a couple weeks before general anesthesia unless it was emergent. I do not plan to have surgery, but I also didn't plan to go through this.
So, I'll at least be gathering information and looking into what the insurance fight entails, assuming my doctor is for this. The goal would be to get it and then get off some meds, but even if I got it and only kept things the same med wise, using the VNS as a boost, and then had it in place if I would need to come off the patch.
So mainly it's just me speculating. I tend to do this when I feel bad; I keep looking for what's next/new. It's a habit entrenched by doctors over the years that nothing helped me, constantly reminding me that new things come out all the time. And by my track record I will try them all. I even remember when Emsam (the patch) came out in June of 2006 talking to my doctor about it being a potential treatment, and it was soon the next AD on my list (because there wasn't anything else).
So there's a long answer.