The Application of Vagus Nerve Stimulation and Deep Brain Stimulation in Depression

Despite the progress in the pharmacotherapy of depression, there is a substantial proportion of treatment-resistant patients. Recently, reversible invasive stimulation methods, i.e. vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). VNS has already received regulatory approval for TRD. This paper reviews the available clinical evidence and neurobiology of VNS and DBS in TRD. The principle of VNS is a stimulation of the left cervical vagus nerve with a programmable neurostimulator. VNS was examined in 4 clinical trials with 355 patients. VNS demonstrated steadily increasing improvement with full benefit after 6–12 months, sustained up to 2 years. Patients who responded best had a low-to-moderate antidepressant resistance. However, the primary results of the only controlled trial were negative. DBS involves stereotactical implantation of electrodes powered by a pulse generator into the specific brain regions. For depression, the targeted areas are the subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, the subgenual cingulated region, and Received: November 9, 2010 Accepted after revision: January 23, 2011 Published online: July 29, 2011 Pavel Mohr, MD, PhD Prague Psychiatric Center Ustavni 91 CZ–181 03 Praha 8 (Czech Republic) Tel. +420 266 003 360, E-Mail mohr @ pcp.lf3.cuni.cz © 2011 S. Karger AG, Basel 0302–282X/11/0643–0170$38.00/0 Accessible online at: www.karger.com/nps D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 9/ 20 17 2 :2 5: 41 P M