Treating Depression with Transcutaneous Auricular Vagus Nerve Stimulation: State of the Art and Future Perspectives

Kong, Jian; Fang, Jiliang; Park, Joel; Li, Shaoyuan; Rong, Pei

doi:10.3389/fpsyt.2018.00020

Cited by 152 publications

(115 citation statements)

References 90 publications

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“…In this sense, SCP lasts long enough to trigger significant changes in the pain pathways and potentially benefit depression recovery despite shifting maladaptative states of the body, through fine tuning the interconnected endocrine, immune, and nervous systems. Similarly, exercise, fish oil consumption, controlled breathing, and other relaxation therapies have been implicated in increasing vagus nerve activity and decreasing pro-inflammatory cytokine release, consistent with observed clinic benefits of vagus nerve stimulation against depression (8,(31)(32)(33). Last but not least, Meditation associated pain has also been described by others (34).…”

Section: Discussionsupporting

confidence: 71%

<strong>Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report</strong>

Huang¹

2018

Preprint

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Major depressive disorder (MDD) is a common mental disorder, which results in seriously impaired condition in the patients and great global disability burden. In light of its quite diverse etiologies, comorbidity with many other diseases, and complex underlying pathology, it has been a great challenge to understand the physiological basis of MDD, which may be a complex of related diseases, rather than a single one. In addition to the partial understanding of MDD, the individual heterogeneities among patients may render the development of a universal treatment an elusive goal. But studying how each of currently available treatments affects the disease can generate useful information to stratify patients into different subtypes for individualized treatments. In this case report, we present the first report of repeated success of using meditation as the only treatment of MDD, compared to initial success but no remission with other conventional antidepressants on the same patient. We hypothesized that the short but continuous natural pain during one-hour meditation sittings has the therapeutic effect to treat depression in the case of this patient and potentially others with MDD. This special opportunity of eliminating tremendous heterogeneity among different individuals has enabled us to probe deeply into the potential mechanism of depression treatments and the complex physiology of depression itself, both of which have likely profound implications in the treatment of other MDD patients as well. More importantly, this case report helps us to dissect one specific component of meditation for its long-known and well-established benefit against depression.

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Section: Discussionsupporting

confidence: 71%

<strong>Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report</strong>

Huang¹

2018

Preprint

View full text Add to dashboard Cite

show abstract

“…In this sense, SCP lasts long enough to trigger significant changes in the pain pathways and potentially benefit depression recovery despite shifting maladaptative states of the body, through fine tuning the interconnected endocrine, immune, and nervous systems. Similarly, exercise, fish oil consumption, controlled breathing, and other relaxation therapies have been implicated in increasing vagus nerve activity and decreasing pro-inflammatory cytokine release, consistent with observed clinic benefits of vagus nerve stimulation against depression (9,(32)(33)(34). Last but not least, Meditation associated pain has also been described by others (35).…”

Section: Discussionsupporting

confidence: 71%

Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report

Huang¹

2018

Preprint

View full text Add to dashboard Cite

Major depressive disorder (MDD) is a common mental disorder, which results in seriously impaired condition in the patients and great global disability burden. In light of its quite diverse etiologies, comorbidity with many other diseases, and complex underlying pathology, it has been a great challenge to understand the physiological basis of MDD, which may be a complex of related diseases, rather than a single one. In addition to the partial understanding of MDD, the individual heterogeneities among patients may render the development of a universal treatment an elusive goal. But studying how each of currently available treatments affects the disease can generate useful information to stratify patients into different subtypes for individualized treatments. In this case report, we present the first report of repeated success of using meditation as the only treatment of MDD, compared to initial success but no remission with other conventional antidepressants on the same patient. We hypothesized that the short but continuous natural pain during one-hour meditation sittings has the therapeutic effect to treat depression in the case of this patient and potentially others with MDD. This special opportunity of eliminating tremendous heterogeneity among different individuals has enabled us to probe deeply into the potential mechanism of depression treatments and the complex physiology of depression itself, both of which have likely profound implications in the treatment of other MDD patients as well. More importantly, this case report helps us dissect one specific component of meditation for its longknown and well-established benefit against depression. Preprints (www.preprints.org) | NOT PEER-REVIEWED |

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“…At present, the outcomes of fMRI studies published to date make it reasonable to surmise that the concha and inner tragus are suitable locations for vagal modulation. Given the therapeutic potential of auricular tVNS (Rong et al 2014;Hyvarinen et al 2015;Straube et al 2015;Kong et al 2018), there remains a need for the cutaneous map of the ABVN to be further refined and the effects of various stimulation parameters and stimulation sites to be determined.…”

Section: Resultsmentioning

confidence: 99%

“…Although Eastern medicine has utilised the analgesic effects of auricular acupuncture for thousands of years (Asher et al 2010;He et al 2012;Usichenko et al 2017), the concept of electrically stimulating the auricle is a more recent one (Ventureyra, 2000). The feasibility of auricular tVNS was first demonstrated using recordings of vagus somato-sensory evoked potentials from the scalp (Fallgatter et al 2003) and since then has been proposed as an effective therapeutic strategy in the management of several clinical disorders including epilepsy (Rong et al 2014), depression (Kong et al 2018), migraine (Straube et al 2015) and tinnitus (Hyvarinen et al 2015). The basis of auricular tVNS is the cutaneous representation of the auricular branch of the vagus nerve (ABVN), also termed Arnold's nerve, which provides somatosensory innervation to the external ear.…”

Section: Introductionmentioning

confidence: 99%

The anatomical basis for transcutaneous auricular vagus nerve stimulation

et al. 2019

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The array of end organ innervations of the vagus nerve, coupled with increased basic science evidence, has led to vagus nerve stimulation (VNS) being explored as a management option in a number of clinical disorders, such as heart failure, migraine and inflammatory bowel disease. Both invasive (surgically implanted) and non‐invasive (transcutaneous) techniques of VNS exist. Transcutaneous VNS (tVNS) delivery systems rely on the cutaneous distribution of vagal afferents, either at the external ear (auricular branch of the vagus nerve) or at the neck (cervical branch of the vagus nerve), thus obviating the need for surgical implantation of a VNS delivery device and facilitating further investigations across a wide range of uses. The concept of electrically stimulating the auricular branch of the vagus nerve (ABVN), which provides somatosensory innervation to several aspects of the external ear, is relatively more recent compared with cervical VNS; thus, there is a relative paucity of literature surrounding its operation and functionality. Despite the increasing body of research exploring the therapeutic uses of auricular transcutaneous VNS (tVNS), a comprehensive review of the cutaneous, intracranial and central distribution of ABVN fibres has not been conducted to date. A review of the literature exploring the neuroanatomical basis of this neuromodulatory therapy is therefore timely. Our review article explores the neuroanatomy of the ABVN with reference to (1) clinical surveys examining Arnold’s reflex, (2) cadaveric studies, (3) fMRI studies, (4) electrophysiological studies, (5) acupuncture studies, (6) retrograde tracing studies and (7) studies measuring changes in autonomic (cardiovascular) parameters in response to auricular tVNS. We also provide an overview of the fibre composition of the ABVN and the effects of auricular tVNS on the central nervous system. Cadaveric studies, of which a limited number exist in the literature, would be the ‘gold‐standard’ approach to studying the cutaneous map of the ABVN; thus, there is a need for more such studies to be conducted. Functional magnetic resonance imaging (fMRI) represents a useful surrogate modality for discerning the auricular sites most likely innervated by the ABVN and the most promising locations for auricular tVNS. However, given the heterogeneity in the results of such investigations and the various limitations of using fMRI, the current literature lacks a clear consensus on the auricular sites that are most densely innervated by the ABVN and whether the brain regions secondarily activated by electrical auricular tVNS depend on specific parameters. At present, it is reasonable to surmise that the concha and inner tragus are suitable locations for vagal modulation. Given the therapeutic potential of auricular tVNS, there remains a need for the cutaneous map of the ABVN to be further refined and the effects of various stimulation parameters and stimulation sites to be determined.

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Treating Depression with Transcutaneous Auricular Vagus Nerve Stimulation: State of the Art and Future Perspectives

Cited by 152 publications

References 90 publications

<strong>Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report</strong>

<strong>Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report</strong>

Short but Continuous Natural Pain during Meditation Sittings for Depression Treatment: A Case Report

The anatomical basis for transcutaneous auricular vagus nerve stimulation

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