Vagus nerve stimulation for depression: efficacy and safety in a European study

Abstract

Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.Method. An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months ; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.Results. The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (o50 % reduction in baseline scores) reached 37 % and remission rates (HAMD-28 score <10) 17 %. Response rates increased to 53 % after 1 year of VNS, and remission rates reached 33 %. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset ; 44 % of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63 % at 3 months of stimulation) and coughing (23 %).Conclusions. VNS therapy was effective in reducing severity of depression ; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol ; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.

Vagus Nerve Stimulation Applied with a Rapid Cycle Has More Profound Influence on Hippocampal Electrophysiology Than a Standard Cycle

“…Vagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy and depression [1,2]. Since gaining regulatory approval, VNS has been used to treat > 70,000 patients worldwide [3].…”

Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS)

“…This pattern is unusual in the treatment of depression, especially in a difficult to treat cohort with prior tolerance to antidepressants (Rush et al, 2006a, b). A recent European trial found slightly better results, but with the same side effects and time course of response (Schlaepfer et al, 2008).…”

Central Sensitization: Clinical Implications for Chronic Head and Neck Pain

“…This contributes to dysfunctional sleep, and anxiety via increased norepinephrine levels. [6,[21][22][23][24][25] • Decreased medullary descending inhibition of nociception, This increases the effective peripheral nociceptive input, and is reflected in lowered pain thresholds, hyperalgesia, allodynia, and greater impact of peripheral sensitization. [8,11,12,[15][16][17]23,[26][27][28][29][30][31][32] • Hypoactivity of the hypothalamic-pituitary-adrenal axis, and autonomic nervous system alterations, produce increased sympathetic tone, low vagal tone, and contribute to immune abnormalities.…”

“…This contributes to the fatigue and malaise often associated with CSS. [5,12,14,20,21,[23][24][25][33][34][35][36][37][38] Utilizing the resultant depression, anxiety, hyperalgesia, allodynia, stress related pain exacerbation, fatigue, and poor sleep, we can establish a list of indicators for central sensitization. Taken alone, with the possible exception of allodynia and stress related pain, none of these are pathognomonic.…”

“…As such, PENS is one of our few cost-effective, non-invasive, low co-morbidity options for the treatment of central sensitization itself, as opposed to responding to the deleterious effects of CS. [1,2,5,6,[8][9][10][12][13][14][15][20][21][22][23][25][26][27][28][42][43][44]53,55] The other broad category of non-pharmaceutical CS intervention encompasses manual therapy, virtual reality, improving stress tolerance, and transcutaneous electric nerve stimulation. These can be thought of as addressing the functional deficits created by the CS.…”