In Reply: Dr Rovin asks about the current status of VNS and deep brain stimulation for treatment-refractory depression and their possible use for Ms A. Vagus nerve stimulation requires surgical implantation of a small stimulator that can be turned on by the patient as needed. Modest antidepressant efficacy was seen over a 1-year period in 2 recent cohort studies1,2 but not in a 10-week randomized controlled trial.3 Common adverse events were voice alteration (68%), cough (29%), and dyspnea (23%), along with dysphasia and neck pain (21%). Infection was observed in 8% of the patients.3 The mechanism of VNS antidepressant affect is unknown, but preliminary results suggest that this treatment normalizes the hypothalamic-pituitary-adrenal stress axis.4 Deep brain stimulation is an experimental procedure that is reported to have an antidepressant effect.5 It is not approved for clinical use.
Salzman C. Treatment-Refractory Depression—Reply. JAMA. 2006;296(2):167–168. doi:10.1001/jama.296.2.167-c
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