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Vital Signs

Summer 2007

Severe Depression Treated with Stimulation Device

A pacemaker-like device that has been used to help control the seizures of epileptics now offers hope for people with disabling, treatment-resistant depression. Vagus Nerve Stimulation (VNS) uses a device the size of a wristwatch that is surgically implanted in the patient's chest. A wire from the device is threaded under the skin to the neck and wrapped around the left vagus nerve, which extends from the abdomen to the brain stem.

VNS involves timed electrical pulses that stimulate the nerve and, in effect, "modulate the part of the brain responsible for mood regulation to improve the patient's symptoms of depression," says UCLA neurosurgeon Antonio DeSalles, M.D. The electro-stimulation may also alter the activity of brain chemicals such as serotonin. In July 2005, the Food and Drug Administration approved VNS as a therapy for chronic, treatment-resistant depression, which affects 4 million Americans. UCLA is one of the few hospitals in Southern California offering this treatment.

VNS implantation is approved only for patients who have attempted and failed at least four antidepressant trials. It is used as an adjunct to antidepressant medications, not as a substitute or replacement, says Randall T. Espinoza, M.D., UCLA psychiatrist. "This is not a treatment for acute episodes of depression. VNS is for people who suffer from serious and chronic depression, and who have not responded to other treatment modalities."

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