The University Of Wisconsin Medical School Department Of Psychiatry is
excited to offer new hope to patients whom are suffering from treatment
resistant or chronic depression. Vagus Nerve Stimulation Therapy (VNS
Therapy) is a new and different treatment modality that is FDA indicated for
treatment of the most difficult to treat patients with depression. It can be
used in conjunction with medications, with no need to taper off of your
current medication regiment.
University of Wisconsin Department of Psychiatry
Treatment Resistant Depression
Vagus Nerve Stimulation Program
VNS @ UW
WISPIC
University Of Wisconsin
Psychiatric Institute and Clinic
6001 Research Park Boulevard
Madison, WI 53719
What is Vagus Nerve Stimulation?
VNS FDA INDICATION:
VNS Therapy is indicated for the adjunctive long-term treatment of chronic
or recurrent depression for patients 18 years of age or older who are
experiencing a major depressive episode and have not had an adequate
response to four or more adequate antidepressant treatments.
HOW VNS THERAPY WORKS:
-VNS Therapy is delivered by a pulse generator—a device like a pacemaker
-The pulse generator sends mild, intermittent pulses through a thin, flexible
wire leading to electrodes attached to the left Vagus nerve
-Because the Vagus nerve does not contain pain fibers, VNS Therapy is
typically painless
-VNS Therapy is regular, automatic, and generally unnoticeable
-VNS Therapy is added to your current antidepressant medications
WHY USE VNS FOR TREATMENT RESISTANT DEPRESSION?
-In early studies, adding VNS Therapy has been shown to succeed when
other antidepressant treatments have not.
-The effectiveness of VNS Therapy seems to improve over time and appears
to last long term.
- After 1 year, 1 in 3 people receiving VNS Therapy experienced significant
mood improvements, compared with 1 in 8 people receiving only other
antidepressant treatments.
- Many people who did not respond immediately to VNS Therapy did
experience improvement over time.
-Most people who responded to VNS Therapy maintained improvement for
at least two years.
-For some people, VNS Therapy reduces the need for antidepressant
medications over time, but does not necessarily reduce the need for
medications.
PLEASE NOTE:
● VNS does not appear to be an immediate treatment. It appears to have a
gradual onset, with efficacy as soon as 2-4 months or later. This efficacy
appears to grow over time and appears to be sustained over the long term.
● Not every patient will respond to VNS therapy. Approximately 30-50% of
people with chronic depression will respond to VNS therapy.
INDICATIONS FOR VNS THERAPY AT UW:
• Patients with unipolar or bipolar depression
• Patients with long term Major Depressive Disorder, lasting
longer than two years
• Patients with or without history of ECT use in lifetime or current
Major Depressive Episode (MDE)
• Patients who are experiencing a MDE and have not had an
adequate response to 4 or more adequate treatments
EXCLUSIONARY CONSIDERATIONS FOR VNS AT UW:
• Acute suicidal thinking or behaviors
• History of schizophrenia, schizoaffective disorder, or delusional
disorder
• Severe, active personality disorder
• Severe, active substance abuse/ dependence
• History of rapid cycling bipolar disorder
• History of previous therapeutic brain surgery or CNS injury
• History of bilateral or left cervical vagotomy
• Progressive neurological diseases other than epilepsy
• Cardiac arrhythmias or other abnormalities
• History of dysautonomias
• History of respiratory diseases or disorders, including dyspnea
and asthma
• History of ulcers (gastric, duodenal and others)
• Other concurrent forms of brain stimulation
WHAT IS OUR ROLE?
After referral to us by your psychiatrist, we will evaluate you (as a “second opinion”) in
our office and attempt to arrange for the implantation at a local hospital where
appropriate or refer you for consideration of inclusion into VNS trials as available. We
will assist with issues such as insurance reimbursement for the procedure as we are able,
with letters of medical necessity and appeals. Once implantation is undertaken, you will
continue to see your primary psychiatrist for medication management and basic
psychiatric care at your normal intervals, as VNS @ UW will not manage medications or
follow non-VNS psychiatric concerns. After implantation, you will be seen in our clinic
at WISPIC for periodic monitoring and adjustments of the VNS Therapy. We have been
specifically trained to manage the implant, adjusting the many parameters as needed for
optimum response.
INSURANCE CAVEAT:
Many insurance policies do not cover VNS Therapy at this time on the on the first
application, or at all, and in most cases multiple appeals are necessary to arrange
coverage. More and more insurances are covering VNS Therapy over time. If all appeals
for insurance coverage of the implantation fail, the implantation will be cancelled unless
you are able to pay the hospital at a rate of APPROXIMATELY $40,000. Post
implantation, your insurance will be billed for these adjustment appointments and if your
insurance does not cover the fee, you may receive a bill for those visits, also.
IF YOU ARE INTERESTED IN BEING EVALUATED FOR VNS
THERAPY FOR CHRONIC DEPRESSION AT UW
Obtain a referral from your primary psychiatrist in the form of a letter and
call our appointment desk at 608-263-6127. You will be asked several
screening questions and an appointment will be arranged as appropriate.
FURTHER QUESTIONS ON VAGUS NERVE STIMULATION THERAPY CAN BE
ANSWERED AT OUR WEBSITE, WWW.PSYCHIATRY.WISC.EDU/VNS OR
BY CONTACTING THE MANUFACTURER AT WWW.VNSTHERAPY.COM
OR 1-877-NOW-4VNS
PLEASE CONTACT YOUR INSURANCE COMPANY TO INQUIRE WHETHER
YOUR POLICY COVERS VNS THERAPY
.