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Beginning in your brainstem and winding down your body, two branches of a communication highway link to your chest, heart, lungs, abdomen, and intestines. These pathways, known as the vagus nerves, transmit signals between your brain and other organs, assisting in regulating heart rate, digestion, and more.
For many years, medical professionals have recognized that tapping into this highway may offer therapeutic advantages. Stimulating the left vagus nerve can alleviate symptoms of epilepsy and support recovery from strokes, for instance. Recently, a WashU Medicine study has shown that for individuals suffering from severe depression, this treatment can be transformative.
To activate a vagus nerve, a surgeon inserts a compact, pacemaker-like device beneath a patient’s skin. This instrument delivers non-invasive electrical impulses into the left vagus nerve located in the neck, which subsequently communicates with the brain. In the recent research, nearly 500 participants with treatment-resistant depression had these devices implanted.
On average, these individuals had previously pursued an astonishing 13 different types of antidepressant therapies without success. Due to the intensity of their symptoms, at least three-quarters of them were unemployed.
“These individuals are profoundly ill, and most have been for quite some time,” states Charles R. Conway, MD, professor of psychiatry at WashU Medicine and the main investigator of the trial. Such intense depression can leave individuals “frozen by life,” he notes, incapable of fulfilling daily tasks.
“What’s truly significant here is that patients themselves were indicating that their lives were improving.”
Charles R. Conway, MD
For a span of one year, Conway and his team activated 249 of the devices, leaving the other 244 deactivated. All participants continued to see their current mental health providers during the trial. Throughout the 12-month study period, they were urged to maintain any existing medications but were advised against initiating new ones.
From the third month onward, the researchers employed several assessment tools to consistently monitor the participants’ symptoms. Off-site researchers performed some evaluations, while patients also reported their own quality of life.
The researchers observed promising trends, especially in the final three months of the study. Participants with their devices switched on enjoyed significantly more time with improved depressive symptoms across multiple measures compared to the control group. They also noted an enhanced capacity to perform daily tasks, alongside an improved quality of life.
“What’s truly significant here is that patients themselves were indicating that their lives were improving,” Conway mentions.
His team has continued to observe the patients following the initial 12-month trial, and many are still experiencing the benefits of antidepressant effects into a second year and beyond. Conway is also investigating whether the therapy helps in reducing suicidal thoughts in those with treatment-resistant depression.
Due to the surgical aspect and the expense of the device, most insurance providers do not authorize vagus nerve stimulation for treatment-resistant depression — but the WashU study may shift that pattern.
The trial was developed in partnership with the Centers for Medicare and Medicaid Services (CMS), aimed at equipping CMS with the data necessary to gain insights into the treatment’s efficacy. Since many private health insurers follow CMS’s guidance, a decision by CMS to cover the device and the surgery could render the therapy accessible to many more individuals in urgent need of relief.
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