Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Vagus nerve stimulation for treatment-resistant mood disorders: a long-term naturalistic study

Authors: Umberto Albert, Giuseppe Maina, Andrea Aguglia, Alberto Vitalucci, Filippo Bogetto, Chiara Fronda, Alessandro Ducati, Michele Lanotte

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Limited therapeutic options are available for patients with treatment-refractory major depression who do not respond to routinely available therapies. Vagus nerve stimulation showed adjunctive antidepressant effect in chronic treatment resistant depression, even though available studies rarely exceed 2-year follow up.
We report a naturalistic 5-year follow up of five patients who received VNS implant for resistant depression (3 patients with major depressive disorder and 2 with bipolar disorder).

Methods

Response was defined as a reduction of the 17-item HDRS total score ≥50% with respect to baseline, remission as a score ≤7.

Results

Response and remission rates were both 40% (2/5) after 1 year, and 60% (3/5) at 5 years. Two patients withdrew from the study because of side effects or inefficacy of stimulation.

Conclusions

Our case series showed that long-term VNS may be effective in reducing severity of depression in a small but significant minority of patients, although two patients had stimulation terminated because of adverse effects and/or refusal to continue the study.
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington DC: American Psychiatric Association; 2000.
2.
Sackeim HA. The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001;62 suppl 16:10–7.PubMed
3.
Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR-D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40.CrossRefPubMed
4.
Nemeroff CB. Prevalence and management of treatment-resistant depression. J Clin Psychiatry. 2007;68(8):17–25.PubMed
5.
Rush AJ, Marangell LB, Sackeim HA, George MS, Brannan SK, Davis SM, et al. Vagus nerve stimulation for treatment-resistant depression: a randomized, controlled acute phase trial. Biol Psychiatry. 2005;58:347–54.CrossRefPubMed
6.
Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905–17.CrossRefPubMed
7.
Berlim MT, Turecki G. Definition, assessment, and staging of treatment-resistant refractory major depression: a review of current concepts and methods. Can J Psychiatry. 2007;52(1):46–54.PubMed
8.
Fekadu A, Wooderson SC, Markopoulou K, Cleare AJ. The Maudsley Staging Method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms. J Clin Psychiatry. 2009;70(7):952–7.CrossRefPubMed
9.
Souery D, Papakostas GI, Trivedi MH. Treatment-resistant depression. J Clin Psychiatry. 2006;67 suppl 6:16–22.PubMed
10.
Wijeratne C, Sachdev P. Treatment-resistant depression: critique of current approaches. Aust N Z J Psychiatry. 2008;42(9):751–62.CrossRefPubMed
11.
Kennedy SH, Giacobbe P, Rizvi SJ, Placenza FM, Nishikawa Y, Mayberg HS, et al. Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry. 2011;168:502–10.CrossRefPubMed
12.
13.
Schlaepfer TE, George MS, Mayberg H. WFSBP guidelines on brain stimulation treatments in psychiatry. World J Biol Psychiatry. 2010;11:2–18.CrossRefPubMed
14.
Schachter SC, Schmidt D. Vagus Nerve Stimulation. London: Martin Dunitz; 2001.
15.
Daban C, Matinez-Aran A, Cruz N, Vieta E. Safety and efficacy of vagus nerve stimulation in treatment-resistant depression. A systematic review. J Affect Disord. 2008;110:1–15.CrossRefPubMed
16.
Rush AJ, Siefert SE. Clinical issues in considering vagus nerve stimulation for treatment-resistant depression. Exp Neurol. 2009;219:36–43.CrossRefPubMed
17.
Armitage R, Husain M, Hoffmann R, Rush AJ. The effects of vagus nerve stimulation on sleep EEG in depression: a preliminary report. J Psychosom Res. 2003;54(5):475–82.CrossRefPubMed
18.
Bajbouj M, Merkl A, Schlaepfer TE, Frick C, Zobel A, Maier W, et al. Two-year outcome of vagus nerve stimulation in treatment-resistant depression. J Clin Psychopharmacol. 2010;30:273–81.CrossRefPubMed
19.
Conway CR, Chibnall JT, Gangwani S, Mintun MA, Price JL, Hershey T, et al. Pretreatment cerebral metabolic activity correlates with antidepressant efficacy of vagus nerve stimulation in treatment resistant major depression: a potential marker for response? J Affect Disord. 2012;139(3):283–90.CrossRefPubMedPubMedCentral
20.
Corcoran CD, Thomas P, Phillips J, O’Keane V. Vagus nerve stimulation in chronic treatment-resistant depression: preliminary findings of an open-label study. Br J Psychiatry. 2006;189:282–3.CrossRefPubMed
21.
Cristancho P, Cristancho MA, Baltuch GH, Thase ME, O’Reardon JP. Effectiveness and safety of vagus nerve stimulation for severe treatment-resistant major depression in clinical practice after FDA approval: outcome at 1 year. J Clin Psychiatry. 2011;72(10):1376–82.CrossRefPubMed
22.
Dell’Osso B, Oldani L, Palazzo MC, Balossi I, Ciabatti MT, Altamura AC. Vagus nerve stimulation in treatment-resistant depression acute and follow-up results of an Italian case series. J ECT. 2013;29:41–4.PubMed
23.
George MS, Rush AJ, Marangell LB, Sackeim HA, Brannan SK, Davis SM, et al. A one-year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression. Biol Psychiatry. 2005;58:364–73.CrossRefPubMed
24.
Kosel M, Brockmann H, Frick C, Zobel A, Schlaepfer TE. Chronic vagus nerve stimulation for treatment-resistant depression increases regional cerebral blood flow in the dorsolateral prefrontal cortex. Psychiatr Res. 2011;191(3):153–9.CrossRef
25.
Marangell LB, Rush AJ, George MS, Sackeim HA, Johnson CR, Husain MM, et al. Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biol Psychiatry. 2002;51:280–7.CrossRefPubMed
26.
Nahas Z, Marangell LB, Husain MM, Rush AJ, Sackeim HA, Lisanby SH, et al. Two-year outcome of vagus nerve stimulation (VNS) for treatment of major depressive episodes. J Clin Psychiatry. 2005;66:1097–104.CrossRefPubMed
27.
Neuhaus AH, Luborzewski A, Rentzsch J, Brakemeier EL, Opgen-Rhein C, Gallinat J, et al. P300 is enhanced in responders to vagus nerve stimulation for treatment of major depressive disorder. J Affect Disord. 2007;100:123–8.CrossRefPubMed
28.
Nierenberg AA, Alpert JE, Gardner-Schuster EE, Seay S, Mischoulon D. Vagus nerve stimulation: 2-year outcomes for bipolar versus unipolar treatment-resistant depression. Biol Psychiatry. 2008;64:455–60.CrossRefPubMed
29.
Rush AJ, George MS, Sackeim HA, Marangell LB, Husain MM, Giller C, et al. Vagus nerve stimulation (VNS) for treatment-resistant depression: a multicenter study. Biol Psychiatry. 2000;47:276–86.CrossRefPubMed
30.
Rush AJ, Sackeim HA, Marangell LB, George MS, Brannan SK, Davis SM, et al. Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005;58:355–63.CrossRefPubMed
31.
Sackeim HA, Rush AJ, George MS, Marangell LB, Husain MM, Nahas Z, et al. Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology. 2001;25:713–28.CrossRefPubMed
32.
Schlaepfer TE, Frick C, Zobel A, Maier W, Heuser I, Bajbouj M, et al. Vagus nerve stimulation for depression: efficacy and safety in a European study. Psychol Med. 2008;4:1–11.
33.
Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, et al. Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects. Brain Stimul. 2013;6:631–40.CrossRefPubMed
34.
Christmas D, Steele JD, Tolomeo S, Sam Eljamel M, Matthews K. Vagus nerve stimulation for chronic major depressive disorder: 12-month outcomes in highly treatment-refractory patients. J Affect Disord. 2013;150:1221–5.CrossRefPubMed
35.
Yuan W, Williams BN. Long-term vagus nerve stimulation for severe refractory depression: a case study with a six-year follow-up. J Neuropsychiatry Clin Neurosci. 2012;24(4):E50–1.CrossRefPubMed
36.
Tisi G, Franzini A, Messina G, Savino M, Gambini O. Vagus nerve stimulation therapy in treatment-resistant depression: a series report. Psychiatry Clin Neurosci. 2014;68:606–11.CrossRefPubMed
37.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders – Patient edition (SCID-I/P, Version 2.0). New York: New York Psychiatric Institute, Biometrics Research Department; 1996.
38.
Martin JLR, Martin-Sanchez E. Systematic review and meta-analysis of vagus nerve stimulation in the treatment of depression: variable results based on study designs. Eur Psychiatry. 2012;27:147–55.CrossRefPubMed
39.
Marangell LB, Suppes T, Zboyan HA, Prashad SJ, Fischer G, Snow D, et al. A 1-year pilot study of vagus nerve stimulation in treatment-resistant rapid-cycling bipolar disorder. J Clin Psychiatry. 2008;69:183–9.CrossRefPubMed
40.
Lanotte MM, Albert U, Ducati A, Maina G. Vagus nerve stimulation in resistant major depression. In: Lavano A, Landi A, Lanotte MM, editors. Handbook of stereotactic and functional neurosurgery. Torino: Edizioni Minerva Medica; 2011. p. 173–82.
Metadata
Title
Vagus nerve stimulation for treatment-resistant mood disorders: a long-term naturalistic study
Authors
Umberto Albert
Giuseppe Maina
Andrea Aguglia
Alberto Vitalucci
Filippo Bogetto
Chiara Fronda
Alessandro Ducati
Michele Lanotte
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0435-8

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Research article

Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP)

Research article

Using social media for support and feedback by mental health service users: thematic analysis of a twitter conversation

Research article

Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

Study protocol

A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia

Study protocol

The Danish 22q11 research initiative

Study protocol

Depression and anxiety during the perinatal period