Vagus Nerve Stimulation Therapy to Manage Treatment-Resistant Depression

Abstract

Source: Moeller, S., et al., Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression. J. Vis. Exp. (2019)

This video demonstrates a clinical protocol for Vagus Nerve Stimulation (VNS) as an adjunctive neurostimulation therapy for treatment-resistant depression (TRD).

Protocol

1. VNS dosing
   1. Commence regular VNS dosing 2 weeks after implantation using the recommended stimulation settings (1.5–3.0 mA; 500 μs pulse width; 20–30 Hz; 30 s on, 5 min off), which must be gradually reached with 0.25–0.5 mA increases per week.
   2. Start dosing (recommended) at 0.25 mA intervals as needed and increase up to 2.00–3.00 mA. Most patients (>90%) will require dosing no higher than 2.00 mA.
2. Dosing in cases of persisting depressive symptoms
   1. Set the on/off time to 30s on/5 min off.
   2. End dosing when a response to VNS is achieved after a maximum of 9–12 months.
3. Dosing alternatives in cases of non-response or partial response
   1. In cases of non-response or partial response, as an alternative to increasing the output current (mA), change the signal frequency (Hz) tuning (typically by decreasing from 30 to 20 Hz) or reduce the off time to 3 min.
4. Dosing in cases of side effects
   1. If side effects occur (mainly laryngopharyngeal dysfunction such as hoarseness, dyspnea, and coughing), which tend to be transitory and directly associated with stimulation of the inferior (recurrent) laryngeal nerve, reduce the maximum mA tuning (typically no lower than 0.75 mA) and/or change the on/off timing.

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
VNS Therapy AspireSR Model 106 Generator	LivaNova Inc.	Primary DI Number: 05425025750061	Implantable Pulse Generator
VNS Therapy Programming Wand Model 2000	LivaNova Inc.	Primary DI Number: 05425025750177	Programming Wand
VNS Therapy Demipulse Model 103 Generator	LivaNova Inc.	Primary DI Number: 5425025750030	Implantable Pulse Generator
Cyberonics Tunneler Model 402	LivaNova Inc.	Primary DI Number: 5425025750238	Tunneler
VNS Therapy Model 502 Accessory Pack		Primary DI Number: 5425025750245	VNS Therapy Accessory Pack
VNS Therapy Model 302 Lead		Primary DI Number: 05425025750108	Implantable Bipolar Lead