Use this checklist to help determine if your patients with treatment-resistant depression (TRD) might benefit from VNS Therapy.

Do you have patients with TRD who:

1. Are experiencing a chronic major depressive episode? Approximately 20% to 35% of patients with major depressive disorder experience a chronic, unremitting course.¹ VNS Therapy may be an appropriate strategy for these patients.



2. Have experienced 4 or more treatment failures? The percentage of patients treated for depression who get well and stay well may be as low as 35%.¹ VNS Therapy has been shown to succeed where other treatments have failed.



3. Have experienced recurrent depression? After one or two prior episodes of depression, patients have a 50% to 90% risk of relapse.² Subsequent episodes are often of longer duration, more severe, and less responsive to treatment.³



4. Need a long-term treatment for their chronic or recurrent depression? Of patients with a major depressive disorder (MDD), 20% to 35% experience a chronic, unremitting course.¹



5. Could benefit from a treatment that improves over time and is sustained long term? VNS Therapy provides efficacy that improves over time and is sustained long term After 24 months of VNS Therapy, 17% of patients with TRD were free of depressive symptoms, and 33% achieved clinical response.⁴



6. Could benefit from a long-term treatment that offers assured compliance? Unlike many other treatments for depression, VNS Therapy provides assured adherence and high continuance rates.



7. Could benefit from a long-term treatment that doesn't interact negatively with other medications? VNS Therapy is safe and tolerable. ⁵ There are no undesired drug interactions with VNS Therapy and concurrent antidepressant medication.⁴

If the answer to any of these questions is yes, you may have patients who could benefit from VNS Therapy.

1. Fava M, Rush AJ, Trivedi MH, et al, for the STAR*D Investigators Group. Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatr Clin North Am. 2003;26:457-494.
2. Zajecka JM. Clinical issues in long-term treatment with antidepressants. J Clin Psychiatry. 2000;61(suppl 2):20-25.
3. Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285:1299-1307.
4. Depression Physician's Manual. VNS Therapy^TM Pulse Model 102 Generator and VNS Therapy^TM Pulse Duo Model Generator. Houston, Tex: Cyberonics, Inc; 2005.
5. Rush AJ, Sackeim HA, Marangell LB, et al. Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005;58:355-363.