Department of Psychiatry
Mental Disorders | Psychiatry | Therapeutics
Objective: To compare the durations of response achieved with adjunctive vagus nerve stimulation (VNS + TAU) vs treatment as usual (TAU) alone in treatment-resistant depression (TRD) over a 5-year period in the TRD registry.
Materials and methods: Data from 271 participants on TAU and 328 participants on VNS + TAU were analyzed. Response was defined as > /=50% decrease in baseline Montgomery-Asberg Depression Rating Scale (MADRS) score at postbaseline visit and was considered retained until the decrease was < 40%. MADRS was obtained quarterly in year 1 and biannually thereafter. Time-to-events were estimated using Kaplan-Meier method and compared using log-rank test. HR was estimated using Cox proportion hazard model.
Results: In the VNS + TAU arm, 62.5% (205/328) of participants had a first response over 5 years compared with 39.9% (108/271) in TAU. The time to first response was significantly shorter for VNS + TAU than for TAU (P < 0.01). For responders in the first year, median time to relapse from first response was 10.1 months (Q1=4.2, Q3=31.5) for VNS + TAU vs 7.3 months (Q1=3.1, Q3=17.6) for TAU (P < 0.01). HR=0.6 (95% CI: 0.4, 0.9) revealed a significantly lower chance for relapse in VNS + TAU. Probability of retaining first response for a year was 0.39 (0.27, 0.51) for TAU and 0.47 (0.38, 0.56) for VNS + TAU. Timing of the onset of the response did not impact the durability of the response.
Conclusion: VNS therapy added to TAU in severe TRD leads to rapid onset and higher likelihood of response, and a greater durability of the response as compared to TAU alone.
depressive disorder, durability of response, longitudinal study, treatment-resistant depression, vagus nerve stimulation
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DOI of Published Version
Neuropsychiatr Dis Treat. 2019 Feb 13;15:457-468. doi: 10.2147/NDT.S196665. eCollection 2019. Link to article on publisher's site
Neuropsychiatric disease and treatment
Kumar, Arun; Bunker, Mark T.; Aaronson, Scott T.; Conway, Charles R.; Rothschild, Anthony J.; Mordenti, Giacomo; and Rush, Augustus J., "Durability of symptomatic responses obtained with adjunctive vagus nerve stimulation in treatment-resistant depression" (2019). Open Access Articles. 3759.
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This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License