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Adjunctive vagus nerve stimulation improves antidepressant efficacy

Adjunctive vagus nerve stimulation improved antidepressant effects among individuals with treatment-resistant depression.

“Vagus nerve stimulation (VNS) has been shown to be efficacious for the long-term management of patients with treatment-resistant depression and is approved by the FDA as an adjunctive treatment for treatment-resistant depression. APA recommends VNS as a treatment option for patients who have not responded to at least four adequate trials of depression treatments, including [electroconvulsive therapy],” Scott T. Aaronson, MD, of Sheppard Pratt Health System, Baltimore, and colleagues wrote.

To compare long-term efficacy of VNS with treatment as usual for depression, researchers conducted a 5-year, prospective, open-label, nonrandomized, observational study among 795 individuals at 61 U.S. sites. Study participants were experiencing a major depressive episode for at least 2 years or had three or more depressive episodes and failed four or more depression treatments, including electroconvulsive therapy.

Participants who received VNS exhibited better clinical outcomes than those who received treatment as usual, including a significantly higher 5-year cumulative response rate (67.6% vs. 40.9%) and remission rate (43.3% vs. 25.7%).

Sub-analysis indicated a significantly higher 5-year cumulative response rate among participants with a history of response to electroconvulsive therapy who received adjunctive VNS, compared with those who received treatment as usual (71.3% vs. 56.9%).

A similar differential response occurred among nonresponders to electroconvulsive therapy.

“Adjunctive VNS resulted in superior outcomes in both effectiveness and mortality over a 5-year period compared with treatment as usual alone for patients with a chronic, severe course of treatment-resistant depression, a patient population for whom evidence-based treatment options do not currently exist,” the researchers concluded. – by Amanda Oldt

Disclosure: Aaronson reports serving as a consultant or adviser for Genomind, LivaNova, Neuronetics, and Otsuka, as a speaker for Lundbeck, Neuronetics, Otsuka, Sunovion, and Takeda; and receiving research support from Neuronetics, the Dalio Foundation, and the Stanley Medical Research Institute. Please see the study for a full list of relevant financial disclosures.