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Vagus nerve stimulation (VNS) therapy in patients with treatment resistant depression: A systematic review and meta-analysis

Authors :
Juliana M. Bottomley
Corinne LeReun
Alex Diamantopoulos
Stephen Mitchell
Bradley N. Gaynes
Source :
Comprehensive Psychiatry, Vol 98, Iss , Pp - (2020)
Publication Year :
2020
Publisher :
Elsevier, 2020.

Abstract

Background: Vagus nerve stimulation (VNS) therapy is approved for treatment-resistant depression (TRD). A recent 5-year comparative study prompted this review of its impact in this very severe population. Previous systematic literature reviews (SLR) cited concerns in terms of missing studies or patient duplication. Methods: This SLR addressed these criticisms, assessed all outcomes of longer-term adjunctive VNS in all studies, irrespective of TRD severity, comparing where feasible with treatment-as-usual (TAU). We searched for adult VNS+TAU studies (January 1, 2000 to June 24, 2019). Comparative and single-arm studies were eligible. All reported efficacy, safety and quality of life (QOL) outcomes were assessed. Where possible, meta-analysis was used to calculate overall pooled effect estimates across studies at several time points. Results: Of 22 identified studies, there were two randomized controlled (RCT), sixteen single-arm and four non-randomized comparative studies. Numerous depression-specific, safety and QOL measures were reported. Meta-analysis was possible for three efficacy [Montgomery-Asberg Depression Rating Scale, Clinician Global Impression-Improvement, Hamilton Rating Scale for Depression] and three safety [serious adverse events, study drop-outs and all-cause mortality] but no QOL measures. Data beyond 2 years was not poolable. Analyses demonstrated that antidepressant benefits improved to 24 months and safety issues were minimal. Heterogeneity was high and statistically significant. Conclusions: Despite limitations in the evidence base, our comprehensive summary of VNS+TAU outcomes suggests that this treatment provides improving benefit and hope for this very hard-to-treat chronic population. More comparative TRD studies should describe safety and QOL. Keywords: Treatment resistant depression, Vagus nerve stimulation (VNS) therapy, Systematic review, Meta-analysis, Long-term outcomes

Subjects

Subjects :
Psychiatry
RC435-571

Details

Language :
English
ISSN :
0010440X
Volume :
98
Issue :
-
Database :
Directory of Open Access Journals
Journal :
Comprehensive Psychiatry
Publication Type :
Academic Journal
Accession number :
edsdoj.076add2b4f40f38990b8f837c0e1a3
Document Type :
article
Full Text :
https://doi.org/10.1016/j.comppsych.2019.152156