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To the Editor: In the Clinical Crossroads discussion of the management of treatment-resistant depression, Dr Salzman¹ did not mention the role of surgery. Vagus nerve stimulation (VNS)² and deep brain stimulation³ have recently been described as adjuvants to medical therapy. It would be helpful if Salzman could comment on the place these techniques have in the management of treatment-resistant depression.

Financial Disclosures: None reported.

Richard A. Rovin, MD, FACS
rarovin@penmed.com
Division of Neurosurgery
Marquette General Hospital
Marquette, Mich

1. Salzman C. A 60-year-old woman who has felt sad for much of her life. JAMA. 2006;295:318-323. FREE FULL TEXT 2. George MS, Rush AJ, Marangell LB, et al. A one-year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression. Biol Psychiatry. 2005;58:364-373. FULL TEXT | PUBMED 3. Mayberg HS, Lozano AM, Voon V, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45:651-660. FULL TEXT | WEB OF SCIENCE | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296:167.

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