Vagus Nerve Stimulation, or VNS, has been available for the treatment of epilepsy since 1997 and was approved by the FDA for the adjunctive treatment of refractory depression in 2005. VNS relies upon the use of a surgically implanted device which delivers periodic stimulation to the vagus nerve. How VNS therapy works is not completely understood; however, several studies have suggested that this technique may be effective for some patients with treatment-resistant depression.
Given the concerns many women – and their treaters – have regarding the use of psychotropic medications during pregnancy, there is a clear need for safe and effective non-pharmacologic options for the treatment of depression during pregnancy. VNS may be an attractive option for women suffering from depression during pregnancy who are reluctant to use or have not responded to conventional antidepressants.
The literature includes one case report of a woman successfully treated with VNS during pregnancy. This patient had suffered from recurrent depression over 10 years and was found to be resistant to six different antidepressants and the atypical antipsychotic risperidone. Substantial improvement was evident after 4 weeks of VNS therapy, and she continued to receive VNS therapy over a period of several years. Approximately three years after initiating VNS therapy, the patient reported she was pregnant. She decided to continue VNS therapy during her pregnancy in combination with citalopram 80 mg per day and bupropion 400 mg per day. Her depression remained in remission during the course of her pregnancy, and she delivered a full-term, healthy child by spontaneous vaginal delivery. At two years of age, her child was noted to exhibit normal age-appropriate development.
While this case report suggests that VNS may be an alternative for the treatment of depression during pregnancy, VNS therapy for refractory depression is considered an experimental treatment.
Ruta Nonacs, MD PhD
To read more about VNS:
Emerging Perspectives: Does VNS Work in Refractory Depression? (Journal Watch)