期刊
COMPREHENSIVE PSYCHIATRY
卷 98, 期 -, 页码 -出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.comppsych.2019.152156
关键词
Treatment resistant depression; Vagus nerve stimulation (VNS) therapy; Systematic review; Meta-analysis; Long-term outcomes
类别
资金
- LivaNova, makers of the VNS therapy device
Background: Vagus nerve stimulation (VNS) therapy is approved for treatment-resistant depression (TRD). A recent 5-year comparative study prompted this review of its impact in this very severe population. Previous systematic literature reviews (SLR) cited concerns in terms of missing studies or patient duplication. Methods: This SLR addressed these criticisms, assessed all outcomes of longer-term adjunctive VNS in all studies, irrespective of TRD severity, comparing where feasible with treatment-as-usual (TAU). We searched for adult VNS +TAU studies (January 1, 2000 to June 24, 2019). Comparative and single-arm studies were eligible. All reported efficacy, safety and quality of life (QOL) outcomes were assessed. Where possible, meta-analysis was used to calculate overall pooled effect estimates across studies at several time points. Results: Of 22 identified studies, there were two randomized controlled (RCI'), sixteen single-arm and four nonrandomized comparative studies. Numerous depression-specific, safety and QOL measures were reported. Metaanalysis was possible for three efficacy [Montgomery-Asberg Depression Rating Scale, Clinician Global Impression-Improvement, Hamilton Rating Scale for Depression] and three safety [serious adverse events, study drop-outs and all-cause mortality] but no QOL measures. Data beyond 2 years was not poolable. Analyses demonstrated that antidepressant benefits improved to 24 months and safety issues were minimal. Heterogeneity was high and statistically significant. Conclusions: Despite limitations in the evidence base, our comprehensive summary of VNS+TAU outcomes suggests that this treatment provides improving benefit and hope for this very hard-to-treat chronic population. More comparative TRD studies should describe safety and QOL. (C) 2020 The Authors. Published by Elsevier Inc.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据