Evidence-Based Reviews

Treatment-resistant depression: Newer alternatives

Current Psychiatry. 2002 February;1(2):11-20

References

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Vagus Nerve Stimulation The NeuroCybernetic Prosthesis System (Cyberonics, Inc., Houston, Tex) stimulates the left cervical vagus nerve for treatment of resistant partial-onset epileptic seizures.

An open treatment trial of vagus nerve stimulation (VNS) for treatment-resistant depression was done based on mood improvement observed in patients treated for seizure disorders. Positron-emission tomographic studies revealed activation of limbic structures and neurochemical and neuronal pathway findings.²³ The investigators reported improvement in a sample of 30 patients with major depressive disorder. Definite conclusions await controlled clinical trials and more work is needed to determine the ultimate mechanisms that might be antidepressant.^23,24

Related resources

Amsterdam JD, Hornig M, Nierenberg AA. Treatment-resistant mood disorders. Cambridge, UK: Cambridge University Press; 2001.
Stahl SM. Essential Psychopharmacology. Cambridge, UK: Cambridge University Press; 1996.
STAR*D Web site: http://www.edc.gsph.pitt.edu/stard

Drug brand names

Bupropion • Wellbutrin, Wellbutrin SR, Zybar
Buspirone • BuSpar, BuSpar DIVIDOSE
Citalopram • Celexa
Fluoxetine • Prozac, Prozac Weekly
Gabapentin • Neurontin
Haloperidol • Haldol, Haldol Decanoate
Lamotrigine • Lamictal
Mirtazapine • Remeron, Remeron Soltab
Modafinil • Provigil
Nefazodone • Serzone
Olanzapine • Zyprexa
Paroxetine • Paxil
Pergolide • Permax
Pramipexole • Mirapex
Reboxetine • Edronax
Risperidone • Risperidal
S-adenosyl-methionine • SAM-e
Sertaline • Zoloft
Tranycypromine • Nardil, Parnate, Marplan
Valproate • Epival, Deprox, Alti-Valproic
Venlafaxine • Effexor, Effexor X12
Ziprasadone • Geodon

Disclosure

Dr. Alpert receives research funding, speaking honoraria or consultation fees from Organon, Forest Pharmaceuticals, GlaxoSmithKline, Pfizer Inc., and Pharmavite.

Dr. Nierenberg receives research funding, speaking honoraria, or consultation fees from Eli Lilly and Co., Wyeth-Ayerst Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Innapharma, BMS, Cyberonics, Lichtner, and Pfizer Inc.