Vagus Nerve Stimulation for Treatment-Resistant Depression: A Randomized, Controlled Acute Phase Trial

Rush, A. John; Marangell, Lauren B.; Sackeïm, Harold A.; George, Mark S.; Brannan, Stephen K.; Davis, Sonia M.; Howland, Robert H; Kling, Mitchel A.; Rittberg, Barry R.; Burke, William J.; Rapaport, Mark Hyman; Zajecka, John; Nierenberg, Andrew A.; Husain, Mustafa M.; Ginsberg, David L.; Cooke, R.G.

doi:10.1016/j.biopsych.2005.05.025

Cited by 497 publications

(276 citation statements)

References 34 publications

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“…74 It has also been recently approved by FDA as an adjunct treatment for treatment-resistant depression. 75 Many of treatment refractory depressed patients in pivotal studies were also suffering from anxiety, which improved simultaneously with depression. However, Treatment-resistant anxiety disorders A Bystritsky true efficacy of this treatment in refractory anxiety populations remains to be explored.…”

Section: Vagus Nerve Stimulation (Vns)mentioning

confidence: 99%

Treatment-resistant anxiety disorders

2006

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Several epidemiological studies confirmed that Anxiety Disorders as a group are the most prevalent psychiatric conditions in the United States. The importance of these conditions is underlined by the fact that they cause significant disability, poor quality of life, alcohol and drug abuse. Anxiety disorders are treatable conditions and respond to the front-line interventions such as serotonin reuptake inhibitors and cognitive behavioral therapy. However, only about 60% of patients respond to those treatments to any significant degree. Many still have residual symptoms or stay treatment refractory. The group of anxiety patients that is resistant to the treatment has been shown to have very poor quality of life and have highest rate of suicidal attempts than any other disorders. Many biological, treatment specific and social factors are affecting treatment resistance. In this paper, we are attempting to review reasons for the treatment resistance. In addition, we would like to review current strategies that could be helpful in reducing treatment resistance and aiding people chronically suffering from these severe and disabling conditions.

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Section: Vagus Nerve Stimulation (Vns)mentioning

confidence: 99%

Treatment-resistant anxiety disorders

2006

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“…121,122 Although initial open trials suggested a substantial acute and long-term benefit in treatment-resistant depression, 123,124 a larger randomized controlled trial failed to show acute efficacy. 125 Evidence exists for modest efficacy at long-term (12 months) follow-up. 126,127 In recent years, chronic deep brain stimulation (DBS) in pathologically overactive neural circuits has been found to produce significant therapeutic benefits in those who suffer from Parkinson's disease.…”

Section: Presumptive Mood Disorder Circuitsmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

131

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Summary:Major depressive disorder and bipolar disorder are severe mood disorders that affect the lives and functioning of millions each year. The majority of previous neurobiological research and standard pharmacotherapy regimens have approached these illnesses as purely neurochemical disorders, with particular focus on the monoaminergic neurotransmitter systems. Not altogether surprisingly, these treatments are inadequate for many individuals afflicted with these devastating illnesses. Recent advances in functional brain imaging have identified critical neural circuits involving the amygdala and other limbic structures, prefrontal cortical regions, thalamus, and basal ganglia that modulate emotional behavior and are disturbed in primary and secondary mood disorders. Growing evidence suggests that mechanisms of neural plasticity and cellular resilience, including impairments of neurotrophic signaling cascades as well as altered glutamatergic and glucocorticoid signaling, underlie the dysregulation in these circuits. The increasing ability to monitor and modulate activity in these circuits is beginning to yield greater insight into the neurobiological basis of mood disorders. Modulation of dysregulated activity in these affective circuits via pharmacological agents that enhance neuronal resilience and plasticity, and possibly via emerging nonpharmacologic, circuitry-based modalities (for example, deep brain stimulation, magnetic stimulation, or vagus nerve stimulation) offers promising targets for novel experimental therapeutics in the treatment of mood disorders.

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“…Since gaining regulatory approval, VNS has been used to treat > 70,000 patients worldwide [3]. Despite numerous preclinical and clinical studies and its widespread application in patients, VNS remains associated with unpredictable and limited therapeutic response rates [1,4], constituting a drawback for an invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Although vagus nerve stimulation (VNS) is widely used, therapeutic mechanisms and optimal stimulation parameters remain elusive. In the present study, we investigated the effect of VNS on hippocampal field activity and compared the efficiency of different VNS paradigms. Hippocampal electroencephalography (EEG) and perforant path dentate field-evoked potentials were acquired before and during VNS in freely moving rats, using 2 VNS duty cycles: a rapid cycle (7 s on, 18 s off) and standard cycle (30 s on, 300 s off) and various output currents. VNS modulated the evoked potentials, reduced total power of the hippocampal EEG, and slowed the theta rhythm. In the hippocampal EEG, theta (4-8 Hz) and high gamma (75-150 Hz) activity displayed strong phase amplitude coupling that was reduced by VNS. Rapid-cycle VNS had a greater effect than standard-cycle VNS on all outcome measures. Using rapid cycle VNS, a maximal effect on EEG parameters was found at 300 μA, beyond which effects saturated. The findings suggest that rapid-cycle VNS produces a more robust outcome than standard cycle VNS and support already existing preclinical evidence that relatively low output currents are sufficient to produce changes in brain physiology and thus likely also therapeutic efficacy.

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Vagus Nerve Stimulation for Treatment-Resistant Depression: A Randomized, Controlled Acute Phase Trial

Abstract: This study did not yield definitive evidence of short-term efficacy for adjunctive VNS in treatment-resistant depression.

Cited by 497 publications

References 34 publications

Treatment-resistant anxiety disorders

Treatment-resistant anxiety disorders

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

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

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