Left vagus nerve stimulation for depression: first implantation case post-fDA approval and review of the literature.

OBJECTIVE: To describe the first case of left vagus nerve stimulation (VNS) following FDA approval and to review this in the context of existing literature. METHODS: A case report of the first patient undergoing VNS post-FDA approval is described. Indications, challenges, post-operative outcomes, and long-term implications are discussed. RESULTS: The patient treated had suicidal ideation, extensive alcoholism related to depression, and severely blunted affect with other major depressive symptoms. He failed multiple antidepressant medications, and over 50 electroconvulsive therapy treatments. Following stimulator implantation and subsequent stimulation, he had significant improvement over two weeks with respect to integration into his family, work, and abstinence from alcohol. In the context of these findings, existing literature on the use of VNS for treatment-resistant depression is reviewed. CONCLUSION: In selected cases, VNS has a significant role in treatment-resistant depression; the data suggest improvement in one-third of patients. Thus, they should be cautioned about side effects and should have a realistic level of expectation.