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

McAllister‐Williams, R. Hamish; Bulmer, Sam; Newton, Karen; Heath, Kelly M.; Cousins, David Andrew; Currie, Alan

doi:10.1016/j.jad.2020.11.020

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…According to a recently published roadmap from the Newcastle Regional Affective Disorders Service, VNS Therapy should be reserved for patients with the capacity to provide informed consent and may not be suitable for patients with a high surgical risk, sleep apnea, a significant personality disorder overshadowing the mood disorder, or a significant active substance misuse disorder. 56 The authors suggest that VNS Therapy should be considered for patients with a primary diagnosis of MDD or bipolar disorder (currently depressed or predominantly depressive polarity); with the current depressive episode of more than two years in duration or the patient has had three previous episodes; and who meet one or more of the following criteria:…”

Section: Preliminary Criteria For Identifying Candidates For Vns Therapymentioning

confidence: 99%

“…Assessments of mood and social function should be completed at baseline, at three and six months following implantation, and at subsequent six-month intervals. 56 A list of validated tools that are relevant to the treatment of depression and are designed to be completed by either clinicians or patients is provided in Tables S3 and S4, respectively.…”

Section: Long-term Treatment Follow-up Of Patients With Vns Therapymentioning

confidence: 99%

See 1 more Smart Citation

Setting Up a Successful Vagus Nerve Stimulation Service for Patients With Difficult-to-Treat Depression

Kraus

Quach

Sholtes

et al. 2022

Neuromodulation: Technology at the Neural Interface

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Background: A substantial number of patients with major depressive disorder (MDD) do not sufficiently remit after the first lines of antidepressant treatments, making them vulnerable to poor clinical outcomes. Patients who have not had adequate resolution of their depressive symptoms after four antidepressant treatments and/or have been experiencing their current episode of MDD for two years or more (with insufficient responses to adequate antidepressant treatments) should be evaluated for antidepressant vagus nerve stimulation (VNS Therapy). Adjunctive VNS Therapy is a promising long-term treatment option for patients with difficult-to-treat depression (DTD), offering significantly improved remission rates in comparison with usual treatments. However, VNS Therapy requires specialized treatment centers to support patients. Materials and Methods:In this narrative review, we aim to outline the necessary steps for setting up an antidepressant VNS Therapy service in an efficient manner.Results: Establishing a VNS Therapy service requires several high-level considerations: initiation of a collaborative multidisciplinary team of health care professionals; developing a surgical pathway for implantation; consideration of reimbursement and health care coverage; setting up a specialist clinic to identify optimal candidates for VNS Therapy; educating patients and their families about VNS Therapy; and training health care providers on patient-specific VNS Therapy treatment and long-term treatment management.Conclusions: Antidepressant VNS Therapy is a promising treatment option for the long-term treatment of patients with DTD. We have successfully initiated four VNS Therapy service centers for DTD in the United States, Austria, and Germany. Based on our experiences and lessons learned, herein, we have provided advice to psychiatric centers planning to set up a VNS Therapy service for their patients with DTD.

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Section: Preliminary Criteria For Identifying Candidates For Vns Therapymentioning

confidence: 99%

Section: Long-term Treatment Follow-up Of Patients With Vns Therapymentioning

confidence: 99%

Setting Up a Successful Vagus Nerve Stimulation Service for Patients With Difficult-to-Treat Depression

Kraus

Quach

Sholtes

et al. 2022

Neuromodulation: Technology at the Neural Interface

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“…However, use of ECT was still low (16%) in DTD group. We do not have data on numbers of patients who were referred to tertiary care for more specialist treatment; for example, alternative neurostimulatory options such as vagus nerve stimulation (VNS) that may have a place in some patients with DTD (McAllister-Williams et al, 2021b).…”

Section: Discussionmentioning

confidence: 99%

The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom

et al. 2022

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Background: Major depressive disorder (MDD) is common and often has sub-optimal response to treatment. Difficult-to-treat depression (DTD) is a new concept that describes ‘depression that continues to cause significant burden despite usual treatment efforts’. Aims: To identify patients with likely DTD in UK secondary care and examine demographic, disease and treatment data as compared with ‘non-DTD’ MDD patients. Methods: Anonymised electronic health records (EHRs) of five specialist mental health National Health Service (NHS) Trusts in the United Kingdom were analysed using a natural language processing model. Data on disease characteristics, comorbidities and treatment histories were extracted from structured fields and using natural language algorithms from unstructured fields. Patients with MDD aged ⩾18 years were included in the analysis; those with presumed DTD were identified on the basis of MDD history (duration and recurrence) and number of treatments prescribed. Results: In a sample of 28,184 patients with MDD, 19% met criteria for DTD. Compared to the non-DTD group, patients with DTD were more likely to have severe depression, suicidal ideation, and comorbid psychiatric and/or physical illness, as well as higher rates of hospitalisation. They were also more likely to be in receipt of unemployment and sickness/disability benefits. More intensive treatment strategies were used in the DTD group, including higher rates of combination therapy, augmentation, psychotherapy and electroconvulsive therapy. Conclusion: This study demonstrates the feasibility of identifying patients with probable DTD from EHRs and highlights the increased burden associated with MDD in these patients.

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“…Die Wirklatenz von 6-12 Monaten impliziert, dass die sonstigen antidepressiven Behandlungen mit Medikation, Neurostimulation und Psychotherapie fortgeführt werden müssen. Für die Auswahl der geeigneten Patienten wurden verschiedene Kriterien vorgeschlagen [7,40].…”

Section: Patientenauswahlunclassified

Vagusnervstimulation (VNS) als Behandlungsoption für Depressionen

Kavakbasi,

Baune

2023

Fortschr Neurol Psychiatr

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ZusammenfassungEinführung Depressionen sind häufig und zeigen bei einem Drittel der Fälle einen therapieresistenten und chronifizierten Verlauf. Die invasive Vagusnervstimulation (VNS) ist eine langfristige Zusatzbehandlungsoption, die in den letzten Jahren zunehmend häufig angewandt wird. Eine CE-Zertifizierung für die Behandlung der chronischen und therapierefraktären Depression besteht seit 2001. Methoden Basierend auf einer systematischen Literaturrecherche geben wir in diesem narrativen Review einen Überblick mit klinischem Schwerpunkt über die invasive VNS als Behandlungsoption bei der Depressionen. Ergebnisse Nach psychiatrischer Indikationsstellung und Aufklärung wird in einem kurzen operativen Eingriff der Impulsgeber im Bereich der linken Brust implantiert. Die Einstellung der Stimulationsparameter erfolgt ambulant-psychiatrisch in den ersten Wochen nach der OP. Das VNS-System wird zunächst in 3-, später in 6-monatigen Intervallen kontrolliert. Die Stimulation erfolgt für 30 Sekunden zwischen 5-minütigen Intervallen. Stimulationssynchrone Heiserkeit ist die häufigste Nebenwirkung. Steigerung noradrenerger und serotonerger Transmission im Gehirn und anti-inflammatorische Effekte werden als Wirkmechanismen diskutiert. Der Behandlungseffekt tritt verzögert nach 6–12 Monaten ein. Die kumulative Responserate nach 5 Jahren liegt für die VNS plus Standardbehandlung bei ca. 67,6% im Vergleich zu 40.9% bei Standardbehandlung ohne VNS. Langfristige positive Effekte auf Lebensqualität, Kognition, Morbidität und Mortalität wurden beschrieben. Schlussfolgerung Die VNS ist eine langfristige, sichere Behandlungsoption bei schwer betroffenen Depressionspatienten mit positivem Effekt auf Symptomschwere, Lebensqualität und kognitive Funktion.

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

Cited by 15 publications

References 18 publications

Setting Up a Successful Vagus Nerve Stimulation Service for Patients With Difficult-to-Treat Depression

Setting Up a Successful Vagus Nerve Stimulation Service for Patients With Difficult-to-Treat Depression

The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom

Vagusnervstimulation (VNS) als Behandlungsoption für Depressionen

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