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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 studies^1-2 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.

The appropriate role of VNS and the ultimate role of deep brain stimulation in . . . [Full Text of this Article]

Carl Salzman, MD
carl_salzman@hms.harvard.edu
Department of Psychiatry
Harvard Medical School
Boston, Mass

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