Good Candidate for VNS?
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Q:  Good Candidate for VNS?

Dear Dr.Phelps,

I am bipolar with comorbidity of ADD including both impulsivity and hyperactivity components.  I've never felt like I'm better completely, but have arrived to "as good as it gets", and I'm not sure that I believe that.

I am taking tegretol, straterra, adderral xr--as well as 10mg tabs, wellbutrin, and serequell, so as you can see I walk a very fine line between efficacy and overstimulation.  It has come to appear over the last couple years I've developed tremors that corrupt fine distal motor movements.  This is distressing in that I'm a R.M.A.(registered medical assistant) and I need a steady hand when performing venipuncture.

Question: Being a touch resistant to conventional drug therapy, and having to deal with ADD every day in opposition to prophylactic bipolar therapy; am I not a good candidate for the Vegus Nerve Stimulator?  I have my own hypothesis but I fail to keep this breif, and can't spell to save my life; so what are your thoughts on VNS to treat such a cruel comorbidity?

Dear JB -- 
In my experience there have been relatively few folks whose "ADD" has not gotten a lot better when I just focused on getting perfect mood stability, though I do have a few folks who then went on to stimulants and did well.  But I have never had a patient on two stimulants let alone 3 (if you count Wellbutrin). On the other hand I don't treat a lot of ADD, so I could be way behind the curve re: how to handle treatment resistant ADD.  Maybe people really do use that kind of approach.  I'd just wonder a little bit about that regimen, although it sounds like you could have gotten there slowly and systematically and that all the ingredients are truly necessary.  

As for VNS, there is far too little experience with it yet.  One thing we know for sure is that it can cause mania just like regular antidepressants do.  So its use in bipolar disorder is likely to be limited by that, and has been very limited so far.  

Sorry, not much for you to go on there.  

Dr. Phelps

Published April 2005


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