Assessment for vagus nerve stimulation in patients with difficult-to-treat depression: a model from the Newcastle Regional Affective Disorders Service (RADS)

Abstract

Background: Vagus nerve stimulation (VNS) has been shown to improve long-term outcomes for some patients with difficult-to-treat depression (DTD).

Objectives: Set out criteria to support the identification of patients for whom VNS is a suitable treatment option.

Methods: Published clinical evidence, coupled with clinical experience garnered at the Regional Affective Disorders Service (RADS; Newcastle, UK) to inform VNS criteria.

Results: Patients with major depressive disorder or bipolar disorder (predominantly depressive) and a history of failed trials of multiple treatment modalities including pharmacotherapy, psychotherapy and/or electroconvulsive therapy (ECT) may be suitable candidates for VNS, if no contraindications are present. In the RADS such patients are offered VNS if they are able to provide informed consent and two specialists agree it is appropriate.

Conclusions: VNS provides a valuable treatment option for DTD when used under appropriate circumstances; these assessment criteria facilitate the identification of patients with greatest potential to benefit.