Cervical vagus nerve stimulation for treatment-resistant depression

• Published in: Neurosurgery clinics of North America Vol. 14; no. 2; p. 275
• Main Authors: Carpenter, Linda L, Friehs, Gerhard M, Price, Lawrence H
• Format: Journal Article
• Language: English
• Published: United States 01-04-2003
• Subjects: Antidepressive Agents - therapeutic use; Brain - pathology; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - pathology; Depressive Disorder, Major - therapy; Drug Resistance; Electric Stimulation - instrumentation; Humans; Magnetic Resonance Imaging; Neck; Vagus Nerve - physiology
• ISSN: 1042-3680
• DOI: 10.1016/S1042-3680(02)00121-3

Therapeutic brain stimulation through left cervical VNS now has established safety and efficacy as a long-term adjunct treatment for medication-resistant epilepsy. There is considerable evidence from both animal and human studies that the vagus nerve carries afferent signals to limbic and higher cortical brain regions, providing a rationale for its possible role in the treatment of psychiatric disorders. Open-label studies in patients with treatment-resistant depression have produced promising results, especially when response rates at longer term (1 year and 2 years) follow-up time points are considered. Short-term (10 weeks) treatment with VNS failed to demonstrate statistical superiority over sham treatment in a recently completed double-blind study, so antidepressant efficacy has not yet been established. Longer term data on VNS in depressed patients as well as further information regarding the possible dose-response relation will help to determine the place of VNS in the armament of therapeutic modalities available for major depression.