Vagus Nerve Stimulation for Treatment-Refractory Depression

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

3 Scopus citations


Treatment-refractory depression (TRD) occurs in a significant subset of individuals suffering from major depressive disorder (MDD). Although there is no strict definition of TRD, it typically refers to individuals with MDD who have not responded to several adequate dose and duration oral antidepressant trials and/or psychotherapy. Treatment options for these individuals remain limited; even more aggressive/invasive treatments (e.g., electroconvulsive therapy [ECT]) do not have sustained benefit in many TRD patients. In this chapter we describe a relatively new neurostimulation method for TRD, Vagus Nerve Stimulation (VNS). Originally employed as a therapy for treatment-refractory epilepsy, VNS has since shown antidepressant efficacy in multiple clinical trials with TRD patients. In this chapter we describe how the electrical stimulus of VNS is delivered, detail the proposed vagal afferent central nervous system pathways relevant to VNS in TRD, and summarize the ever-expanding clinical trials in TRD. Further, we approach a practical application of VNS in TRD by detailing its use in clinical practice, including pre- and post-operative management, electrical stimulus dose titration, and typical clinical outcomes. Finally, we discuss future clinical and research directions for VNS in TRD.

Original languageEnglish
Title of host publicationNeuromodulation in Psychiatry
PublisherWiley Blackwell
Number of pages18
ISBN (Electronic)9781118801086
ISBN (Print)9781118801048
StatePublished - Mar 5 2016


  • Antidepressant
  • Major depressive disorder
  • Treatment-resistant depression
  • Vagus nerve stimulation


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