Cited by 496Vagus Nerve Stimulation ResearchNeurological disorders and treatmentsTreatment of Major Depression

VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms

Nemeroff, Charles B, Mayberg, Helen S, Krahl, Scott E, McNamara, James, Frazer, Alan, Henry, Thomas R, George, Mark S, Charney, Dennis S +1 more·2006·Neuropsychopharmacology

Abstract

Currently available therapeutic interventions for treatment-resistant depression, including switch, combination, and augmentation strategies, are less than ideal. Observations of mood elevation during vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy suggested a role for VNS therapy in refractory major depression and prompted clinical investigation of this neurostimulation modality. The VNS Therapy System has been available for treatment of pharmacoresistant epilepsy since 1997 and was approved by the US Food and Drug Administration for treatment-resistant depression in July, 2005. The physiology of the vagus nerve, mechanics of the VNS Therapy System, and efficacy and safety in pharmacoresistant epilepsy are reviewed. Promising results of VNS therapy for treatment-resistant depression have been forthcoming from both acute and long-term studies, evidenced in part by progressive improvements in depression rating scale scores during the 1st year of treatment with maintenance of response thereafter. VNS therapy is well tolerated in patients with either pharmacoresistant epilepsy or treatment-resistant depression. As in epilepsy, the mechanisms of VNS therapy of treatment-resistant depression are incompletely understood. However, evidence from neuroimaging and other studies suggests that VNS therapy acts via innervation of the nucleus tractus solitarius, with secondary projections to limbic and cortical structures that are involved in mood regulation, including brainstem regions that contain serotonergic (raphe nucleus) and noradrenergic (locus ceruleus) perikarya that project to the forebrain. Mechanisms that mediate the beneficial effects of VNS therapy for treatment-resistant depression remain obscure. Suggestions for future research directions are described.

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Crossref · 10.1038/sj.npp.1301082

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  • Nerve neuroprosthetics offer applications such as control of bladder function, management of depression, and restoration of sensory perception in amputees.

    “Whether by activating nerves through electrical stimulation or by reading their electrical signals, nerve neuroprosthetics offer a myriad of applications such as the control of bladder function (Brindley et al., 1982), management of depression (Nemeroff et al., 2006), and restoration of sensory perception in amputees (D'Anna et al., 2019).”
  • Through direct or indirect anatomic connections via the NTS, the vagus nerve has structural connections with several mood regulating limbic and cortical brain areas.

    “Through direct or indirect anatomic connections via the NTS, the vagus nerve has structural connections with several mood regulating limbic and cortical brain areas (82).”

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Authors
Nemeroff, C. B., Mayberg, H. S., Krahl, S. E., McNamara, J., Frazer, A., Henry, T. R., George, M. S., Charney, D. S., & Brannan, S. K.
Affiliations
  • Emory University (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Duke Medical Center (US)
  • The University of Texas at San Antonio Health Science Center (US)
  • Medical University of South Carolina (US)
  • VA Greater Los Angeles Healthcare System (US)
Corresponding author
Nemeroff, Charles B
Venue
Neuropsychopharmacology
Published
2006-04-19
Volume
31
Issue
7
Pages
1345-1355
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
OpenAlex
W2094533610
Cited by
496
References
70
Citations by year
2026: 29 · 2025: 34 · 2024: 37 · 2023: 45 · 2022: 33 · 2021: 26 · 2020: 10 · 2019: 24 · 2018: 27 · 2017: 16 · 2016: 28 · 2015: 25 · 2014: 14 · 2013: 17 · 2012: 22
FWCI
2.41
Type
journal article
Language
en
Update notices
erratum (2006-07-31)
Open access
closed
Locations
  • Neuropsychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
vagus nerve stimulation, treatment-resistant depression, drug-resistant epilepsy, nucleus tractus solitarius, serotonergic projections, noradrenergic projections, mood regulation, neurostimulation, treatment efficacy and safety
MeSH terms
Animals, Major Depressive Disorder, Drug Resistance, Electric Stimulation Therapy, Evaluation Studies as Topic, Humans, Neurobiology, Time Factors, Vagus Nerve

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