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Vagus nerve stimulation in psychiatry: a systematic review of the available evidence

Abstract

Invasive and non-invasive vagus nerve stimulation (VNS) is a promising add-on treatment for treatment-refractory depression, but is also increasingly evaluated for its application in other psychiatric disorders, such as dementia, schizophrenia, somatoform disorder, and others. We performed a systematic review aiming to give a detailed overview of the available evidence of the efficacy of VNS for the treatment of psychiatric disorders. Data derived from animal models, experimental trials without health-related outcomes, case reports, single-session studies, and reviews were excluded. From 1292 publications, 33 records were included for further analyses: 25 focused on VNS as treatment of unipolar or bipolar major depressive disorder and one investigated the neurocognitive improvement after VNS in major depressive disorder. Seven focused on the improvement of cognitive function in Alzheimer´s disease, improvement of schizophrenia symptoms, treatment of obsessive compulsive disorder (OCD), panic disorder (PD) and post-traumatic stress disorder (PTSD), treatment resistant rapid-cycling bipolar disorder, treatment of fibromyalgia, and Prader–Willi syndrome. A total of 29 studies used invasive VNS, while four studies used non-invasive, transcutaneous VNS. Only 7 out of 33 studies investigated conditions other than affective disorders. The efficacy data of VNS in affective disorders is promising, whereas more in controlled and naturalistic studies are needed. In other conditions like schizophrenia, Alzheimer’s disease, OCD, PD, PTSD, and fibromyalgia, either no effects or preliminary data on efficacy were reported. At this point, no final conclusion can be made regarding the efficacy of VNS to improve symptoms in psychiatric disorders other than in affective disorders.

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Correspondence to Camelia-Lucia Cimpianu.

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C Cimpianu reports no conflicts of interest. W. Strube has received paid speakership by Mag and More. U. Palm received a paid speakership from NeuroCare Group. P. Falkai was honorary speaker for Janssen-Cilag, Astra-Zeneca, Eli Lilly, Bristol Myers-Squibb, Lundbeck, Pfizer, Bayer Vital, SmithKline Beecham, Wyeth, and Essex. During the last 5 years, but not presently, he was a member of the advisory boards of Janssen-Cilag, AstraZeneca, Eli Lilly, and Lundbeck. A. Hasan received a paid speakership from Desitin, Otsuka and Lundbeck. He was member of an advisory board of Roche and Lundbeck.

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Cimpianu, CL., Strube, W., Falkai, P. et al. Vagus nerve stimulation in psychiatry: a systematic review of the available evidence. J Neural Transm 124, 145–158 (2017). https://doi.org/10.1007/s00702-016-1642-2

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Keywords

  • Brain stimulation
  • Vagus nerve stimulation
  • Psychiatric disorders
  • Evidence-based psychiatry