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.
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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.
Perspectives
There is so little information available on what to do when many treatments fail. My fondest hope is this paper will bring about better availability of a long term chronic treatment (VNS) for a severe long term chronic illness.
Scott Aaronson
Sheppard Pratt Health System
Read the Original
This page is a summary of: A 5-Year Observational Study of Patients With Treatment-Resistant Depression Treated With Vagus Nerve Stimulation or Treatment as Usual: Comparison of Response, Remission, and Suicidality, American Journal of Psychiatry, July 2017, American Psychiatric Association,
DOI: 10.1176/appi.ajp.2017.16010034.
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