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Wednesday, November 2, 2011

New Data Suggests VNS Effective in Managing Depression in Everyday Practice

on February 11, 2011 | Permalink | Comments (0)
A study released earlier this week from the University of Pennsylvania School of Medicine demonstrated that Vagus Nerve Stimulation (VNS) is as effective in treating depression in clinical practice as was shown in clinical trials. VNS is a treatment where short bursts of electric activity are administered to targeted loci in the brain via the vagus nerve. A pulse generator is implanted under the skin near the chest and leads are threaded to the vagus nerve. VNS was approved for epilepsy in 1997 and for treatment-resistant depression in 2005. Though approved for depression, VNS is used for the most part as a last ditch option for medically refractory epilepsy. Increasing recognition, clinical data, and established reimbursement paradigms have allowed VNS to be used more widely for epilepsy than for depression.
In this new study, published in the Journal of Clinical Psychiatry by Cristancho and colleagues, VNS was implanted in 15 patients with treatment-resistant depression (10 had Major Depressive Disorder and 5 had Bipolar Disorder). Though the study was relatively small and performed on a limited number of people, the findings do show that VNS is a feasible and effective treatment for depressed patients who do not respond positively to medication management. Using the Beck Depression Inventory, the mean scores fell from 37.8 to 24.6 from using VNS for 12 months, with one case of remission. When using the Hamilton Depression Rating Scale instead of the Beck Depression Inventory as an outcome measure, six patients (43 percent) responded well to VNS and two patients went into remission at 12 months.
Studies such as these demonstrate that VNS is a viable treatment option for depression. Additional studies, with larger sample sizes and increased follow-up times, will add to the repertoire of clinical data justifying VNS for depression and likely enhance uptake. While clinical trials and practical outcomes may increase acceptance of VNS for depression, insurance coverage and reimbursement decisions will ultimately influence use. Since VNS is a surgical procedure with device costs of approximately $20K, most patients will only undergo treatment if covered by insurance. Currently, restrictive reimbursement from Medicare and commercial payers has hindered VNS use. The University of Pennsylvania study researchers noted that most patients were denied VNS coverage until a detailed clinical justification for VNS use was submitted by the provider.

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