Most recently, vagus stimulation by implanted pacemaker, a treatment method previously used for the control of epileptic seizures, has been applied to the treatment of depression (George et al., 2000). Thirty treatment-resistant, but non-psychotic, depressed patients received an implant of a pacemaker stimulating the left cervical vagus nerve by bipolar electrodes, attached below the cardiac branch. Stimulation was mostly with 0.5-ms pulse-width, at 20-30 Hz, with 30-s stimulation periods alternating with 5-min breaks. This open protocol was sustained over 10 weeks, with a response rate of 40% at the end point. Patients had failed to respond to at least two robust treatment attempts, and had an average duration of illness episode of 10 years (0.3-49.5 years). The most common stimulation-related adverse
Cochrane risk difference plot (random effects)
DL pooled risk difference = 0.164056 (95% CI = 0.070678 to 0.257433)
event was voice alteration (usually hoarseness) in 40%, and there was pain, coughing and dysphagia (10% each). Longer-term follow-up appeared to support the efficacy of VNS (Marangell et al., 2002). Considering the severity of illness, this is an encouraging result that warrants further controlled studies.
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