Author: Christoph Kraus1, Darin Quach2, David M Sholtes3, Erhan Kavakbasi4, Renske De Zwaef5, Maxine Dibué6, John Zajecka7, Bernhard T Baune8
Affiliation:
1 Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
2 Department of Psychiatry, Washington University in Saint Louis and Barnes Jewish Hospital, St. Louis, MO, USA.
3 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Capital & Coast District Health Board, Wellington, New Zealand.
4 Department of Psychiatry, University of Münster, Münster, Germany.
5 Clinical Affairs, LivaNova Belgium SA, Zaventem, Belgium.
6 Medical Affairs Europe, Neuromodulation, LivaNova Deutschland GmbH (LivaNova PLC owned subsidiary), Munich, Germany.
7 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
8 Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia. Electronic address: bernhard.baune@ukmuenster.de.
Conference/Journal: Neuromodulation
Date published: 2022 Feb 2
Other:
Special Notes: doi: 10.1016/j.neurom.2021.12.010. , Word Count: 281
Background:
A substantial number of patients with major depressive disorder (MDD) do not sufficiently remit after the first lines of antidepressant treatments, making them vulnerable to poor clinical outcomes. Patients who have not had adequate resolution of their depressive symptoms after four antidepressant treatments and/or have been experiencing their current episode of MDD for two years or more (with insufficient responses to adequate antidepressant treatments) should be evaluated for antidepressant vagus nerve stimulation (VNS Therapy). Adjunctive VNS Therapy is a promising long-term treatment option for patients with difficult-to-treat depression (DTD), offering significantly improved remission rates in comparison with usual treatments. However, VNS Therapy requires specialized treatment centers to support patients.
Materials and methods:
In this narrative review, we aim to outline the necessary steps for setting up an antidepressant VNS Therapy service in an efficient manner.
Results:
Establishing a VNS Therapy service requires several high-level considerations: initiation of a collaborative multidisciplinary team of health care professionals; developing a surgical pathway for implantation; consideration of reimbursement and health care coverage; setting up a specialist clinic to identify optimal candidates for VNS Therapy; educating patients and their families about VNS Therapy; and training health care providers on patient-specific VNS Therapy treatment and long-term treatment management.
Conclusions:
Antidepressant VNS Therapy is a promising treatment option for the long-term treatment of patients with DTD. We have successfully initiated four VNS Therapy service centers for DTD in the United States, Austria, and Germany. Based on our experiences and lessons learned, herein, we have provided advice to psychiatric centers planning to set up a VNS Therapy service for their patients with DTD.
Keywords: Depression; VNS; difficult-to-treat depression; treatment-resistant depression; vagus nerve stimulation.
PMID: 35123881 DOI: 10.1016/j.neurom.2021.12.010
