Document Detail


VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms.
MedLine Citation:
PMID:  16641939     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Currently available therapeutic interventions for treatment-resistant depression, including switch, combination, and augmentation strategies, are less than ideal. Observations of mood elevation during vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy suggested a role for VNS therapy in refractory major depression and prompted clinical investigation of this neurostimulation modality. The VNS Therapy System has been available for treatment of pharmacoresistant epilepsy since 1997 and was approved by the US Food and Drug Administration for treatment-resistant depression in July, 2005. The physiology of the vagus nerve, mechanics of the VNS Therapy System, and efficacy and safety in pharmacoresistant epilepsy are reviewed. Promising results of VNS therapy for treatment-resistant depression have been forthcoming from both acute and long-term studies, evidenced in part by progressive improvements in depression rating scale scores during the 1st year of treatment with maintenance of response thereafter. VNS therapy is well tolerated in patients with either pharmacoresistant epilepsy or treatment-resistant depression. As in epilepsy, the mechanisms of VNS therapy of treatment-resistant depression are incompletely understood. However, evidence from neuroimaging and other studies suggests that VNS therapy acts via innervation of the nucleus tractus solitarius, with secondary projections to limbic and cortical structures that are involved in mood regulation, including brainstem regions that contain serotonergic (raphe nucleus) and noradrenergic (locus ceruleus) perikarya that project to the forebrain. Mechanisms that mediate the beneficial effects of VNS therapy for treatment-resistant depression remain obscure. Suggestions for future research directions are described.
Authors:
Charles B Nemeroff; Helen S Mayberg; Scott E Krahl; James McNamara; Alan Frazer; Thomas R Henry; Mark S George; Dennis S Charney; Stephen K Brannan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2006-04-19
Journal Detail:
Title:  Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology     Volume:  31     ISSN:  0893-133X     ISO Abbreviation:  Neuropsychopharmacology     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-16     Completed Date:  2006-09-05     Revised Date:  2011-05-18    
Medline Journal Info:
Nlm Unique ID:  8904907     Medline TA:  Neuropsychopharmacology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1345-55     Citation Subset:  IM    
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. cnemero@emory.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Depressive Disorder, Major / therapy*
Drug Resistance
Electric Stimulation Therapy*
Evaluation Studies as Topic
Humans
Neurobiology*
Time Factors
Vagus Nerve* / anatomy & histology
Comments/Corrections
Erratum In:
Neuropsychopharmacology. 2006 Oct;31(10):2329

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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