A Vagal Nerve Stimulation case: Solving the Daunting Challenge of Discovering the Etiology of Mental Disorders using Neuromodulation.

Abraham Peled MD

We are dealing with a patient suffering from Treatment Resistant Depression (TRD) but also with Perseverative ideation manifested by repeated concerns of depression-related content, i.e., the 'inability to feel emotions toward love ones.'???

The DSM is a descriptive diagnostic conceptualization for mental disorders it is not Etiological, thus it doesn’t inform anything about the causes of the disorders. This is because the causes (etiology) of mental disorders are unknown (Including Depression).

Due to lack of etiology for mental disorders, in Neuromodulation we have an EXPLANATORY GAP regarding our intervention; for example, we do not know why Vagal Nerve Stimulation (VNS) has an antidepressant effect, and if it can also have an anti-perseverative effect.

To bridge this gap, we need a ‘NEUROANALYTIC’ approach one that is based on reconceptualization of mental disorders based on computational-neuroscience method (1). ?

VNS delivers spread cortical stimulation via its Afferent hippocampal cortical pathways, thus acting as plasticity inducing energy which is known to accompany an antidepressant effect.

More interestingly VNS has a desynchronization effect (antiepileptic). Such desynchronization can eliminate Preseveration because ‘Neuroanalysis’ teaches us that preservation occur when neuronal networks reactivate due to hyper synchronization, thus desynchronization should reduce the hyper-synchronized activity underlying perseverative ideation. ???????????

Now reconceptualizing Depression as ‘Atrophic Hypoplasticity’ etiological condition, and ‘Preseverations’ as hyper-synchronized Neuronal-network dynamics, shows us the therapeutic link between the psychiatric phenomenology (description of symptoms) and the brain-dynamics (etiology) of the mental disorder (i.e., Depression and Persevertions).

By reveres-engineering-like thinking about Neuromodulation we can backtrack and reformulate mental disorders as brain disorders and begin to solve the daunting challenge of discovering the etiology of mental disorders ??????????