title: Vagus nerve stimulation therapy in a patient with treatment-resistant depression: a case report of long-term follow-up and battery end-of-service.
abstract: This is the first case report of a patient who received long-term (69-month) adjunctive vagus nerve stimulation (VNS) therapy for treatment-resistant depression (TRD) and reached VNS battery end-of-service (EOS). The patient is a 41-year-old female with depression who entered a study of adjunctive VNS therapy for TRD. Her Hamilton Rating Scale for Depression (HAM-D) scores dropped from a mean of 33.5 (pre-implantation baseline period) to 16 at the end of the 12-week acute-phase treatment period, and then fluctuated from <7 (normal range) to scores in the moderately depressed range (approximately 20) during long-term follow-up. Three and one-half years after VNS implantation, the patient's HAM-D scores began to increase from a score of 18 to a peak score of 27 approximately 16 months later (5-years post-implantation). The patient subsequently reported that she could no longer feel stimulation from the device and device interrogation 2 weeks later indicated battery EOS. The patient was hospitalized due to worsened depression, the pulse generator was replaced, and medication adjusted. HAM-D scores through the subsequent 9 months of follow-up returned to a pattern of fluctuations within the range noted during the long-term follow-up period prior to VNS battery EOS.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas 77030, USA. jmartine@bcm.tmc.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Martinez
authors.forename: Holly A
authors.initials: HA
authors.lastname: Zboyan
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology*