Rush A John, Siefert Susan E
Clinical Sciences Duke-NUS Graduate Medical School, No. 2 Jalan Bukit Merah 169547, Singapore.
Exp Neurol. 2009 Sep;219(1):36-43. doi: 10.1016/j.expneurol.2009.04.015. Epub 2009 May 3.
This review briefly discusses the clinical and basic science rationale for vagus nerve stimulation (VNS) in treatment-resistant depression (TRD). As the number of treatment failures for depression increases, the likelihood of achieving remission during acute treatment decreases, and the risk of relapse increases with the number of treatment failures. Two open trials of adjunctive VNS for TRD showed positive acute results and a growing benefit over time. The results of the acute randomized controlled trial were not significant for the primary outcome (response by HRSD-24), but the secondary measure (IDS-SR-30) was significant for VNS. A 12-month nonrandomized comparative analysis of patients receiving adjunctive VNS with TRD patients receiving treatment as usual showed significant results favoring VNS. Post hoc analyses found that this difference was not accounted for baseline differences nor by intercurrent treatment. While VNS is well tolerated, the optimal dosing strategies have not been determined nor have clinically useful predictors of who will respond to the treatment. Given the profound effects of TRD upon the daily lives of patients and that a substantial number of VNS patients receive benefit, VNS is a useful option for managing patients with TRD.
本综述简要讨论了迷走神经刺激（VNS）治疗难治性抑郁症（TRD）的临床和基础科学原理。随着抑郁症治疗失败次数的增加，急性治疗期间实现缓解的可能性降低，且复发风险随治疗失败次数的增加而增加。两项TRD辅助VNS的开放试验显示出积极的急性治疗结果，且随着时间推移益处不断增加。急性随机对照试验的主要结局（HRSD-24评分反应）结果不显著，但次要指标（IDS-SR-30）对VNS有显著意义。一项对接受辅助VNS的患者与接受常规治疗的TRD患者进行的为期12个月的非随机对照分析显示，结果显著有利于VNS。事后分析发现，这种差异既不能用基线差异来解释，也不能用同期治疗来解释。虽然VNS耐受性良好，但尚未确定最佳给药策略，也没有确定谁会对该治疗产生反应的临床有用预测指标。鉴于TRD对患者日常生活有深远影响，且大量VNS患者从中受益，VNS是治疗TRD患者的一个有用选择。
