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Vagus nerve stimulation for treatment-resistant mood disorders: a long-term naturalistic study.

Albert U, Maina G, Aguglia A, Vitalucci A, Bogetto F, Fronda C, Ducati A, Lanotte M - BMC Psychiatry (2015)

Bottom Line: Response was defined as a reduction of the 17-item HDRS total score ≥50% with respect to baseline, remission as a score ≤7.Two patients withdrew from the study because of side effects or inefficacy of stimulation.Our case series showed that long-term VNS may be effective in reducing severity of depression in a small but significant minority of patients, although two patients had stimulation terminated because of adverse effects and/or refusal to continue the study.

View Article: PubMed Central - PubMed

Affiliation: Rita Levi Montalcini Department of Neuroscience, Mood and Anxiety Disorders Unit, University of Torino, via Cherasco 11, 10126, Turin, Italy. umberto.albert@unito.it.

ABSTRACT

Background: Limited therapeutic options are available for patients with treatment-refractory major depression who do not respond to routinely available therapies. Vagus nerve stimulation showed adjunctive antidepressant effect in chronic treatment resistant depression, even though available studies rarely exceed 2-year follow up. We report a naturalistic 5-year follow up of five patients who received VNS implant for resistant depression (3 patients with major depressive disorder and 2 with bipolar disorder).

Methods: Response was defined as a reduction of the 17-item HDRS total score ≥50% with respect to baseline, remission as a score ≤7.

Results: Response and remission rates were both 40% (2/5) after 1 year, and 60% (3/5) at 5 years. Two patients withdrew from the study because of side effects or inefficacy of stimulation.

Conclusions: Our case series showed that long-term VNS may be effective in reducing severity of depression in a small but significant minority of patients, although two patients had stimulation terminated because of adverse effects and/or refusal to continue the study.

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Related in: MedlinePlus

HDRS, MADRS and CGI-S scores across time for Patient 5 (male, 61 years, Bipolar Disorder type II, no comorbid diagnoses).
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Fig2: HDRS, MADRS and CGI-S scores across time for Patient 5 (male, 61 years, Bipolar Disorder type II, no comorbid diagnoses).

Mentions: A total of five patients met the inclusion criteria and had the VNS generator implanted. The mean ± SD age of the patients was 56.6 ± 7.3 years (range, 48–66 years). Three patients had a Major Depressive Disorder (60.0%) and the remaining two patients had a Bipolar Disorder (one BD type I and one BD type II). Socio-demographic and clinical data are summarized in Table 1. Concerning the duration of the current MDE, three patients fulfilled DSM-IV criteria for chronic (>2 years) major depression (all three had a diagnosis of unipolar major depression). Pre-implant history of the two BD patients was carefully recorded by means of direct interview, family members’ interview (when available) and medical records review. The first patient (Figure 1) had a history of BD type I with onset at age 26; he had more than 10 lifetime MDEs, with 8 admissions to psychiatric wards and 2 suicide attempts during previous episodes. Despite being on mood stabilizer (valproic acid), during the last two years preceding VNS implant he showed 3 MDEs (not considering the current one) without (hypo) manic episodes, but with intervals between depressive episodes lasting less than 3 months. Treatments with adjunctive lamotrigine or quetiapine did not result in stable remission; adjunctive antidepressants in the current episode did not resolve depressive symptomatology. The second patient (Figure 2) had BD type II, with onset at age 36. He also had more than 10 lifetime MDEs, a history of 1 prior suicide attempt, and had, during the last two years prior to VNS implant, 2 long-lasting MDEs (not considering the current one). He spent, during the last two years prior to surgery, a total of 5 months only without a MDE (although without complete remission), despite being treated with valproic acid, quetiapine, lamotrigine, and four different antidepressants (two of them during the current MDE). No hypomanic episodes were recorded in the last two years.Table 1


Vagus nerve stimulation for treatment-resistant mood disorders: a long-term naturalistic study.

Albert U, Maina G, Aguglia A, Vitalucci A, Bogetto F, Fronda C, Ducati A, Lanotte M - BMC Psychiatry (2015)

HDRS, MADRS and CGI-S scores across time for Patient 5 (male, 61 years, Bipolar Disorder type II, no comorbid diagnoses).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384299&req=5

Fig2: HDRS, MADRS and CGI-S scores across time for Patient 5 (male, 61 years, Bipolar Disorder type II, no comorbid diagnoses).
Mentions: A total of five patients met the inclusion criteria and had the VNS generator implanted. The mean ± SD age of the patients was 56.6 ± 7.3 years (range, 48–66 years). Three patients had a Major Depressive Disorder (60.0%) and the remaining two patients had a Bipolar Disorder (one BD type I and one BD type II). Socio-demographic and clinical data are summarized in Table 1. Concerning the duration of the current MDE, three patients fulfilled DSM-IV criteria for chronic (>2 years) major depression (all three had a diagnosis of unipolar major depression). Pre-implant history of the two BD patients was carefully recorded by means of direct interview, family members’ interview (when available) and medical records review. The first patient (Figure 1) had a history of BD type I with onset at age 26; he had more than 10 lifetime MDEs, with 8 admissions to psychiatric wards and 2 suicide attempts during previous episodes. Despite being on mood stabilizer (valproic acid), during the last two years preceding VNS implant he showed 3 MDEs (not considering the current one) without (hypo) manic episodes, but with intervals between depressive episodes lasting less than 3 months. Treatments with adjunctive lamotrigine or quetiapine did not result in stable remission; adjunctive antidepressants in the current episode did not resolve depressive symptomatology. The second patient (Figure 2) had BD type II, with onset at age 36. He also had more than 10 lifetime MDEs, a history of 1 prior suicide attempt, and had, during the last two years prior to VNS implant, 2 long-lasting MDEs (not considering the current one). He spent, during the last two years prior to surgery, a total of 5 months only without a MDE (although without complete remission), despite being treated with valproic acid, quetiapine, lamotrigine, and four different antidepressants (two of them during the current MDE). No hypomanic episodes were recorded in the last two years.Table 1

Bottom Line: Response was defined as a reduction of the 17-item HDRS total score ≥50% with respect to baseline, remission as a score ≤7.Two patients withdrew from the study because of side effects or inefficacy of stimulation.Our case series showed that long-term VNS may be effective in reducing severity of depression in a small but significant minority of patients, although two patients had stimulation terminated because of adverse effects and/or refusal to continue the study.

View Article: PubMed Central - PubMed

Affiliation: Rita Levi Montalcini Department of Neuroscience, Mood and Anxiety Disorders Unit, University of Torino, via Cherasco 11, 10126, Turin, Italy. umberto.albert@unito.it.

ABSTRACT

Background: Limited therapeutic options are available for patients with treatment-refractory major depression who do not respond to routinely available therapies. Vagus nerve stimulation showed adjunctive antidepressant effect in chronic treatment resistant depression, even though available studies rarely exceed 2-year follow up. We report a naturalistic 5-year follow up of five patients who received VNS implant for resistant depression (3 patients with major depressive disorder and 2 with bipolar disorder).

Methods: Response was defined as a reduction of the 17-item HDRS total score ≥50% with respect to baseline, remission as a score ≤7.

Results: Response and remission rates were both 40% (2/5) after 1 year, and 60% (3/5) at 5 years. Two patients withdrew from the study because of side effects or inefficacy of stimulation.

Conclusions: Our case series showed that long-term VNS may be effective in reducing severity of depression in a small but significant minority of patients, although two patients had stimulation terminated because of adverse effects and/or refusal to continue the study.

Show MeSH
Related in: MedlinePlus