Vagus Nerve Stimulation Therapy Randomized to Different Amounts of Electrical Charge for Treatment-Resistant Depression: Acute and Chronic Effects

Aaronson, Scott T.; Carpenter, Linda L.; Conway, Charles R.; Reimherr, Frederick W.; Lisanby, Sarah H.; Schwartz, Thomas L.; Moreno, Francisco; Dünner, David L.; Lesem, Michael D.; Thompson, Peter M.; Husain, Mustafa M.; Vine, Craig J.; Banov, Michael D.; Bernstein, Lisa; Lehman, Robert B.; Brannon, Guy E.; Keepers, George A.; O’Reardon, John P.; Rudolph, Richard L.; Bunker, Mark

doi:10.1016/j.brs.2012.09.013

Cited by 135 publications

(117 citation statements)

References 26 publications

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“…Only studies including Treatment as Usual (TAU) or Sham VNS controls are included (see Berry et al, 2013; for a broader meta-analysis). That is, case studies (e.g., Borckardt et al, 2006; Critchley et al, 2007), studies of VNS efficacy without controls (e.g., Christmas et al, 2013; Cristancho et al, 2011), studies comparing only various levels of VNS intensity (e.g., Aaronson et al, 2013), and studies focused solely on specific biological and cognitive consequences of VNS in depression, such as effects on pain perception, cravings, and flavor perception (e.g., Borckardt et al, 2005; Sperling et al, 2011) are not included. All findings noted are statistically significant.…”

Section: Figurementioning

confidence: 99%

Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.

Harshaw

2015

Psychological Bulletin

201

147

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Depression is characterized by disturbed sleep and eating, a variety of other, nonspecific somatic symptoms, and significant somatic comorbidities. Why there is such close association between cognitive and somatic dysfunction in depression is nonetheless poorly understood. An explosion of research in the area of interoception—the perception and interpretation of bodily signals—over the last decade nonetheless holds promise for illuminating what have until now been obscure links between the social, cognitive-affective, and somatic features of depression. This paper reviews rapidly accumulating evidence that both somatic signaling and interoception are frequently altered in depression. This includes comparative studies showing vagus-mediated effects on depression-like behaviors in rodent models as well as studies in humans indicating both dysfunction in the neural substrates for interoception (e.g., vagus, insula, anterior cingulate cortex) and reduced sensitivity to bodily stimuli in depression. An integrative framework for organizing and interpreting this evidence is put forward which incorporates (a) multiple potential pathways to interoceptive dysfunction; (b) interaction with individual, gender, and cultural differences in interoception; and (c) a developmental psychobiological systems perspective, emphasizing likely differential susceptibility to somatic and interoceptive dysfunction across the lifespan. Combined with current theory and evidence, it is suggested that core symptoms of depression (e.g., anhedonia, social deficits) may be products of disturbed interoceptive-exteroceptive integration. More research is nonetheless needed to fully elucidate the relationship between mind, body, and social context in depression.

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Section: Figurementioning

confidence: 99%

Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.

Harshaw

2015

Psychological Bulletin

201

147

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“…Greater VNS intensity triggers greater release of plasticity enhancing neuromodulators [17]. Increasing VNS intensity improves outcomes in epilepsy and depression patients [18,19]. Though VNS changes cortical maps, it is not yet known whether such changes vary with stimulus parameters such as intensity.…”

Section: Introductionmentioning

confidence: 99%

Cortical Map Plasticity as a Function of Vagus Nerve Stimulation Intensity

et al. 2016

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Background Pairing sensory or motor events with vagus nerve stimulation (VNS) can reorganize sensory or motor cortex. Repeatedly pairing a tone with a brief period of VNS increases the proportion of primary auditory cortex (A1) responding to the frequency of the paired tone. However, the relationship between VNS intensity and cortical map plasticity is not known. Objective/Hypothesis The primary goal of this study was to determine the range of VNS intensities that can be used to direct cortical map plasticity. Methods The rats were exposed to a 9 kHz tone paired with VNS at intensities of 0.4, 0.8, 1.2, or 1.6 mA. Results In rats that received moderate (0.4-0.8 mA) intensity VNS, seventy-five percent more cortical neurons were tuned to frequencies near the paired tone frequency. A two-fold effective range is broader than expected based on previous VNS studies. Rats that received high (1.2-1.6 mA) intensity VNS had significantly fewer neurons tuned to the same frequency range compared to the moderate intensity group. Conclusion This result is consistent with previous results documenting that VNS is memory enhancing as a non-monotonic relationship of VNS intensity.

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“…Results from studies investigating the efficacy of VNS in mixed age samples remain inconclusive possibly due to the absence of consensus as to the optimum stimulation parameters. Notably though, the first randomised study to systematically compare response to differing doses of VNS has found that while there was significant improvement regardless of electrical dose strength, there was significantly greater longevity of response with high and medium doses [123].…”

Section: Tdcs Safety and Cognition In The Elderlymentioning

confidence: 98%

Neuromodulation Therapies for Geriatric Depression

Gálvez

Alonzo

et al. 2015

Curr Psychiatry Rep

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Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

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Vagus Nerve Stimulation Therapy Randomized to Different Amounts of Electrical Charge for Treatment-Resistant Depression: Acute and Chronic Effects

Cited by 135 publications

References 26 publications

Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.

Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.

Cortical Map Plasticity as a Function of Vagus Nerve Stimulation Intensity

Neuromodulation Therapies for Geriatric Depression

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