Abstract
In addition to electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS) is one of the approved neurostimulation tools for treatment of major depression. VNS is particularly used in therapy-resistant depression (TRD) and exhibits antidepressive and augmentative effects. In long-term treatment, up to two-thirds of patients respond. This mini-review provides a comprehensive overview of augmentation pharmacotherapy and neurostimulation-based treatment strategies, with a special focus on VNS in TRD, and provides practical clinical advice for how to select TRD patients for add-on neurostimulation treatment strategies.
Highlights
Major depressive disease (MDD) is recognized worldwide as a frequently recurring or chronic and highly prevalent psychiatric disease (Beaucage et al, 2009; Maske et al, 2015)
Evidence-based psychosocial interventions (Hunot et al, 2013; Hayes and Hofmann, 2017) are under development, up to 50% of all patients with MDD do not achieve remission with currently available treatments (Zhou et al, 2015; Murphy et al, 2017). This subtype of MDD is classified as therapy-resistant depression (TRD) (Rush et al, 2006a,b; Mojtabai, 2017), which is defined by a lack of response or failure to fully respond or achieve remission after trials of at least two proven antidepressants with adequate dosing and duration (Bschor, 2010; Wiles et al, 2014; Holtzmann et al, 2016)
RTMS response rates are poor in patients for whom electroconvulsive therapy (ECT) has failed (Kedzior et al, 2017). These findings indicate that repetitive transcranial magnetic stimulation (rTMS) should be considered prior to pursuing ECT or as an add-on strategy and that patients who have not responded to ECT are unlikely to respond to rTMS treatment sessions alone (McClintock et al, 2018)
Summary
Major depressive disease (MDD) is recognized worldwide as a frequently recurring or chronic and highly prevalent psychiatric disease (Beaucage et al, 2009; Maske et al, 2015). In addition to alterations in the typical domains of affective and mood symptoms, MDD is directly associated with high rates of suicidality and overall mortality as well as a well-established increased risk of death due to comorbid somatic disorders, such as myocardial infarction and stroke (Lasserre et al, 2017; Slepecky et al, 2017; Tesio et al, 2017; Vandeleur et al, 2017). In addition to psychotherapeutic strategies, pharmacotherapy is usually used as a first-line treatment for MDD, yet many patients do not sufficiently respond to monotherapy with an established medication, such as a selective serotonin reuptake inhibitor (SSRI) (Fava and Davidson, 1996). Some progress has been made in developing safe and efficacious antidepressant treatments and novel pharmacotherapy-based treatment strategies, such as ketamine or selective NMDA receptor subtype 2B (NR2B) antagonists (Serafini et al, 2015; Andrade, 2017) with mechanisms other than monoamine neurotransmitter reuptake inhibition.
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