Efficacy of Vagus Nerve Stimulation in Treatment Resistant Depression
What is it about?
Patients with unipolar or bipolar depression who had greater than four failures of antidepressants were able to choose between receiving treatment as usual (TAU, N=301) or getting implanted with a vagus nerve stimulation device in addition to treatment as usual (VNS, N=494). Over the course of five years, patients with VNS were much more likely to meet response and/or remission criteria and have a significant reduction in suicidal ideation than patients getting just TAU.
Why is it important?
There is little to guide treatment for patients who have failed more than four adequate trials of medication. The study is the largest (almost 800 patients) and longest (five years) ever reported. VNS showed remarkable efficacy is a severely treatment resistant population. A non-coverage determination (NCD) was made by the Centers for Medicare and Medicaid Services in 2007 has limited the availability of VNS through third party payers. This study while naturalistic supports re-consideration of this decision.