Author: Lojine Y Kamel1, Willa Xiong2, Britt M Gott1, Arun Kumar3, Charles R Conway4
1 Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States of America.
2 Department of Psychiatry, Georgetown University School of Medicine, 2115 Wisconsin Ave NW, Suite 200, Washington, DC 20007, United States of America.
3 Takeda Pharmaceuticals International Co., 40 Landsdowne Street, Cambridge, MA 02139, United States of America.
4 Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States of America. Electronic address: firstname.lastname@example.org.
Conference/Journal: J Neurol Sci
Date published: 2022 Jan 29
Other: Volume ID: 434 , Pages: 120171 , Special Notes: doi: 10.1016/j.jns.2022.120171. , Word Count: 230
In this review, we provide an overview of essential clinical trials examining the effect of vagal nerve stimulation (VNS) in treatment-resistant depression (TRD), the applicable neuroanatomy of the vagus nerve, and the proposed mechanism of action (MOA) of VNS in TRD. Vagal nerve stimulation (VNS) is currently the only FDA-approved neurostimulation treatment for severe treatment-resistant depression (TRD). The implanted VNS device sends electrical impulses to the left cervical vagus nerve, resulting in stimulation of afferent vagal brainstem pathways known to be associated with mood regulation. Within the last decade, several clinical trials have attempted to further elucidate this effect specifically in TRD. Early clinical trials including the D01, D02, and D03 trials showed promising evidence of the antidepressant efficacy and durability of VNS as a treatment for TRD. Later trials comparing VNS and treatment-as-usual (TAU) resulted in similar findings regarding antidepressant efficacy and durability. VNS was additionally found to be beneficial in improving quality of life and suicidality among unipolar TRD patients and depression among bipolar TRD patients. Ongoing and future studies such as the RECOVER trial continue to investigate the psychiatric benefits of VNS within the TRD population. Although the MOA of VNS in TRD is still not fully understood, recent brain imaging studies and animal studies have proven instrumental in addressing this knowledge gap.
Keywords: Antidepressant; Treatment resistant depression; Vagal nerve stimulation; Vagus nerve.
PMID: 35158102 DOI: 10.1016/j.jns.2022.120171