Concomitant use of vagus nerve stimulation and electroconvulsive therapy for treatment-resistant depression.
OBJECTIVE
This study explored the use of electroconvulsive therapy (ECT) in the pivotal study of vagus nerve stimulation (VNS) for treatment-resistant depression.


METHODS
The clinical characteristics and outcomes of study participants who received ECT during the first 12 months of VNS were compared with those who did not receive ECT. Physicians were instructed to turn off VNS during administration of ECT.


RESULTS
Of 205 (evaluable sample) patients who received VNS, 14 also received ECT. Participants who received ECT had a statistically significant greater number of hospital admissions (P = 0.037, Wilcoxon) and number of suicide attempts during their lifetimes (P= 0.022, Fisher exact test). Of 55 responders (> or =50% reduction in Hamilton Rating Scale for Depression-24 questions [HRSD-24] scores) after 12 months of VNS, 3 had received ECT. Of 32 remitters (HRSD-24 score, < or =9), 2 had received ECT. Administration of ECT did not affect the implanted VNS device, and the presence of the implanted VNS device did not affect the administration of ECT.


CONCLUSIONS
Electroconvulsive therapy and VNS are not mutually exclusive. They can be used safely and effectively either sequentially or concurrently. Each can be prescribed as the depressive condition warrants-ECT for emergently worsening depressive symptoms and maintenance therapy and VNS for chronic, long-term therapy.
Burke
Michael J
MJ
Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS. mjburke@kumc.edu
Husain
Mustafa M
MM
D000328:Adult; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D004311:Double-Blind Method; D004351:Drug Resistance; D004599:Electric Stimulation Therapy; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*