Vagus nerve stimulators for depression

[marie337]

One of the neurosurgeons that I'm with this month asked me if I had worked with any psychiatrists who monitor vagus nerve stimulators for depression. I certainly have not, and I wonder if this is taught anywhere. She said she placed a couple during her residency that were indicated for depression. But, she also said that neurologists don't like to regulate them because they don't get paid for seeing depressed patients and not very many psychiatrists are trained to work with them. Has anyone seen them used with any success?

 

[BobA]

VNS is FDA approved for treatment resistent depression. However, insurance companies will not pay for this. VNS is very expensive (maybe $40K?).

However, insurance companies will pay for VNS for epilepsy. Sometimes docs just say a person with treatment resistant depression has epilepsy just so that insurance will pay for VNS. (I think this is unethical).

We do some VNS for depression here and everyone who gets it is enrolled in research trials. Anectodally some people do well and some don't, but "n" is very very small and it's difficult to enroll enough people to do a good study because we rely on finding people with insurance that's willing to pay for it.

I think that VNS could go in the "read between the lines" category. If it were any good, the VNS company would invest money to enroll people in a trial to prove it's effectiveness to convince insurance to pay for it. The fact that they haven't been willing to pay to conduct a good study says to me that it's probably not that good. (since they've probably done their own preliminary trials and likely haven't published the results).

(FYI - my favorite "read between the lines" non-study is chantix vs. wellbutrin for smoking cessation. Chantix paid for a head to head RCT to prove it's superior. However, wellbutrin is most effective when combined with the nicotine patch. Chantix cannot be combined with the patch. So Chantix set the trial up to make it look like it's superior to wellbutrin, but in reality wellbutrin and the patch might work better than chantix alone. Why compare chantix with the "second best" known treatment?)

 

[marie337]

(FYI - my favorite "read between the lines" non-study is chantix vs. wellbutrin for smoking cessation. Chantix paid for a head to head RCT to prove it's superior. However, wellbutrin is most effective when combined with the nicotine patch. Chantix cannot be combined with the patch. So Chantix set the trial up to make it look like it's superior to wellbutrin, but in reality wellbutrin and the patch might work better than chantix alone. Why compare chantix with the "second best" known treatment?)

Thanks for the info! It sounds like I won't be monitoring any of these stimulators in my future. I was happy that she was making conversation though. I've had some good discussions about psych with these neurosurgeons.

I love studies that are designed based on the desired outcome. They are so clinically useful . What stinks though is that drug reps run around spewing the results without giving the whole story!