Vagus nerve stimulation (VNS) for treatment-resistant depressions: a multicenter study

• Published in: Biological psychiatry (1969) Vol. 47; no. 4; pp. 276 - 286
• Main Authors: Rush, A.John, George, Mark S, Sackeim, Harold A, Marangell, Lauren B, Husain, Mustafa M, Giller, Cole, Nahas, Ziad, Haines, Stephen, Simpson, Richard K, Goodman, Robert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.02.2000; Elsevier Science
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Biological and medical sciences; bipolar disorder; Depression; Depressive Disorder, Major - therapy; Electric Stimulation Therapy - methods; electrical stimulation; Electroconvulsive Therapy - methods; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Reference Values; Single-Blind Method; Treatment Outcome; treatment-resistant depression; Treatments; Vagus Nerve - physiology; Vagus Nerve Stimulation (VNS); treatment-resistant depression; electrical stimulation; bipolar disorder; Vagus Nerve Stimulation (VNS); Human; Mood disorder; Treatment efficiency; Multicenter study; Electrical stimulus; Tolerance; Depression; Bipolar disorder; Recurrent; Treatment; Electrotherapy; Autonomic nervous system; Adult; Antidepressant agent; Vagus nerve
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(99)00304-2

Background: Vagus Nerve Stimulation (VNS) delivered by the NeuroCybernetic Prosthesis (NCP) System was examined for its potential antidepressant effects. Methods: Adult outpatients ( n = 30) with nonpsychotic, treatment-resistant major depressive ( n = 21) or bipolar I ( n = 4) or II ( n = 5; depressed phase) disorders who had failed at least two robust medication trials in the current major depressive episode (MDE) while on stable medication regimens completed a baseline period followed by NCP System implantation. A 2-week, single-blind recovery period (no stimulation) was followed by 10 weeks of VNS. Results: In the current MDE (median length = 4.7 years), patients had not adequately responded to two ( n = 9), three ( n = 2), four ( n = 6), or five or more ( n = 13) robust antidepressant medication trials or electroconvulsive therapy ( n = 17). Baseline 28-item Hamilton Depression Rating Scale (HDRS 28) scores averaged 38.0. Response rates (≥50% reduction in baseline scores) were 40% for both the HDRS 28 and the Clinical Global Impressions—Improvement index (score of 1 or 2) and 50% for the Montgomery–Åsberg Depression Rating Scale. Symptomatic responses (accompanied by substantial functional improvement) have been largely sustained during long-term follow-up to date. Conclusions: These open trial results suggest that VNS has antidepressant effects in treatment-resistant depressions.