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Vagus nerve stimulation for depression: efficacy and safety in a European study

Published online by Cambridge University Press:  04 January 2008

T. E. Schlaepfer ,
C. Frick ,
A. Zobel ,
W. Maier ,
I. Heuser ,
M. Bajbouj ,
V. O'Keane ,
C. Corcoran ,
R. Adolfsson  and
M. Trimble
...Show all authors
T. E. Schlaepfer*
Affiliation:
Department of Psychiatry, University Hospital, Bern, Switzerland Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, MD, USA
C. Frick
Affiliation:
Department of Psychiatry, University Hospital, Bern, Switzerland Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
A. Zobel
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
W. Maier
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
I. Heuser
Affiliation:
Psychiatrische Klinik der FU Berlin, Berlin, Germany
M. Bajbouj
Affiliation:
Psychiatrische Klinik der FU Berlin, Berlin, Germany
V. O'Keane
Affiliation:
Beaumont Hospital, Department of Psychiatry, Dublin, Ireland
C. Corcoran
Affiliation:
Beaumont Hospital, Department of Psychiatry, Dublin, Ireland
R. Adolfsson
Affiliation:
University Hospital Umea, Umea, Sweden
M. Trimble
Affiliation:
National Hospital for Neurology and Neurosurgery, Department of Neuropsychiatry and Neurology, London, UK
H. Rau
Affiliation:
Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany Alcohol Rehabilitation Clinic, Wilhelmsdorf, Germany
H.-J. Hoff
Affiliation:
Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
F. Padberg
Affiliation:
Departments of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
F. Müller-Siecheneder
Affiliation:
Departments of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
K. Audenaert
Affiliation:
University Hospital Gent, Gent, Belgium
D. Van den Abbeele
Affiliation:
University Hospital Gent, Gent, Belgium
K. Matthews
Affiliation:
Ninewells Hospital and Medical School, Department of Psychiatry, Dundee, UK
D. Christmas
Affiliation:
Ninewells Hospital and Medical School, Department of Psychiatry, Dundee, UK
Z. Stanga
Affiliation:
Department of Psychiatry, University Hospital, Bern, Switzerland
M. Hasdemir
Affiliation:
Lindenhof Hospital, Department of Neurosurgery, Bern, Switzerland
*
*Address for correspondence: T. E. Schlaepfer, M.D., Department of Psychiatry/University Hospital, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. (Email: schlaepf@jhmi.edu)
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Abstract

Background

Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.

Method

An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.

Results

The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (⩾50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%).

Conclusions

VNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.

Keywords

Brain stimulationmajor depressiontreatment resistancevagus nerve
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 651 - 661
Copyright
Copyright © Cambridge University Press 2008

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