Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression. A systematic review

Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain.
Journal of Affective Disorders (Impact Factor: 3.71). 04/2008; 110(1-2):1-15. DOI: 10.1016/j.jad.2008.02.012
Source: PubMed

ABSTRACT The main objective of this review of the literature was to evaluate the safety and efficacy of Vagus Nerve Stimulation (VNS) in treatment-resistant depression (TRD) by means of systematic review and meta-analysis.
A systematic review of the literature was made using the major databases (Medline, Psychological Abstracts, Current Contents), beginning in January 2000 and ending in September 2007. Ninety-eight references were found, but only 18 add-on studies met the required quality criteria and were included in this review. Only one double-blind, randomized study was available and therefore a meta-analysis was not feasible.
In a majority of the preliminary open studies selected for this review, VNS was associated with a significant reduction of the depressive symptoms (primary outcome: Hamilton Depression Rating Scale, HDRS) in the short and long term. Unfortunately, the only double-blind study gave rather inconclusive results. Generally, VNS is reported to be a safe and feasible procedure, despite its invasive nature.
VNS seems to be an interesting new approach to treating TRD. However, despite the promising results reported mainly in open studies, further clinical trials are needed to confirm its efficacy in major depression. Moreover, studies on its mechanism of action and cost-effectiveness are also required to better understand and develop VNS therapy for affective disorder.

  • Source
    • "Barowsky & Schwartz To establish state of the matter regarding augmentation Augmentation and (2006) and combining strategies with lithium, thyroid hormone combination and other compounds, for TRD Bauer et al. (2009) Meta-analysis of trials of Venlafaxine in the treatment Venlafaxine of MDD, including treatment resistant depression and long term relapse prevention Berlim & Turecki (2007) To summarize and discuss the conceptual and operational TRD definition definitions of TRD by systematically reviewing RCTs on its somatic treatments Bschor & Bauer (2006) It reviews the clinical evidence and hypotheses on the mode Augmentation with Lithium of action of lithium augmentation Bschor & Baethge To summarise the scientific findings on switching antidepressants Swtching ADs (2010) to manage TRD patients Daban et al. (2008) To evaluate the safety and efficacy of VNS in TRD VNS Dodd et al. (2005) To review published trials on combination antidepressants with a Combining ADs view to inform clinical practice Fekadu et al. (2009) To assess how people with TRD fare in the longer term, from Long-term outcomes information gathered in observational studies. We were not interested for TRD patients in acute treatment trials of TRD, but in studies which provided data on the longer term outcome of those who either had ongoing depressive symptoms after treatment or who had previously experienced TRD but responded successfully to treatment Lam et al. (2008) To find clear evidence of rTMS for TRD focusing on clinical outcomes rTMS that are relevant to clinicians Lam et al. (2002) To critically evaluate the evidence for efficacy of combining Combining ADs antidepressants McPherson et al. (2005) To evaluate psychological interventions with treatment resistant Psychological treatments depression Ruhé et al. (2012) To identify staging models for TRD and compare them regarding Staging methods predictive utility and reliability Stimpson et al. (2002) To give a summation of the findings of the clinical studies on DBS Deep Brain Stimulation and TRD that have been concluded thus far Sarnecki & Temel (2011) To summarise the findings from all RCTs that have assessed the Pharmacological and efficacy of a pharmacological or psychological intervention for TRD psychological interventions Thomas et al. (2010) To review all the evidence of lamotrigine's effectiveness in treatment Augmentation with resistant depression after at least one failed antidepressant trial Lamotrigine Trivedi et al. (2011) To examine the utility of psychotherapy in managing treatment Psychotherapy resistant depression Note. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.
    International Journal of Clinical and Health Psychology 05/2014; 14(2):145-153. DOI:10.1016/S1697-2600(14)70048-1 · 2.79 Impact Factor
  • Source
    • "Other non-psychiatric medications were allowed. The main exclusion criteria were a history of atypical depression, psychotic symptoms, schizophrenia , schizoaffective disorder, delusional disorders, rapid-cycling bipolar disorder, acute suicidality or active substance abuse (Daban et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study was to assess the effects of vagus nerve stimulation (VNS) therapy on regional cerebral blood flow (rCBF) in depressed patients. Regional cerebral blood flow (rCBF) was assessed by [(99m)Tc]-HMPAO-single photon emission computed tomography (SPECT) before and after 10weeks of VNS in patients participating in an open, uncontrolled European multi-center study investigating efficacy and safety of VNS. Patients suffered from major depression, with a baseline score of≥20 on the 24-item Hamilton Depression Rating Scale (HDRS) and had been unsuccessfully treated with at least two adequately prescribed antidepressant drugs. Data of 15 patients could be analyzed using SPM 2. After 10weeks of VNS (20Hz, 500μs pulse width, stimulation during 30s every 5min at the maximal comfortable level) rCBF was increased in the left dorsolateral/ventrolateral prefrontal cortex (Brodmann areas 46 and 47) and decreased in the right posterior cingulate area, the lingual gyrus and the left insula. Our findings are in line with earlier results which showed that VNS increases rCBF in the left dorsolateral prefrontal cortex. The modulation of the activity in this region could be associated with the antidepressant efficacy of VNS.
    Psychiatry Research 02/2011; 191(3):153-9. DOI:10.1016/j.pscychresns.2010.11.004 · 2.68 Impact Factor
  • Source
    • "La résistance thérapeutique aux approches psychopharmacologiques et psychothérapiques est une difficulté fréquente à laquelle le clinicien est directement confronté : elle est rapportée de façon constante dans la littérature avec une fréquence de 20 % et 30 % concernant les troubles dépressifs. D'autres approches thérapeutiques semblent donc incontournables pour optimiser les soins : les psychothérapies structurées telles que la TCC et les TIP ont montré leurs efficacité dans les troubles anxieux et dépressifs, les approches psychoéducatives améliorent l'observance dans les pathologies chroniques [9]. Les approches biologiques non médicamenteuses telle que l'électroconvulsivothérapie restent une thérapeutique de référence dans le traitement des troubles de l'humeur et garde une indication dans les troubles schizophréniques résistants [34]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Resistance to psychopharmacological and psychotherapeutic therapies is a frequent difficulty clinicians are confronted to, with a frequency of 20 to 30 % concerning depression disorders. Other therapeutic approaches hence seem unavoidable to optimize treatments: structured psychotherapies such as behavioural and interpersonal therapies have shown their efficiency in anxiety and depression disorders, psychoeducational approaches help better observance in chronic pathologies. Biological and non medicinal approaches such as electroconvulsive therapy are still a therapy of reference for treating mood disorders and remain an indication for resisting schizophrenic disorders.
    Annales Médico-psychologiques revue psychiatrique 09/2010; DOI:10.1016/j.amp.2010.06.020 · 0.15 Impact Factor
Show more