Evaluating Your Progress
Place an X on the line to describe your general experience over the past 2 weeks.
VNS Therapy procedure date (Month / Day / Year): _______________
Most recent VNS Therapy adjustment (Month / Day / Year): _______________
Date (Month / Day / Year): _______________
My energy level is...
LOW ______________________________ HIGH
My emotional state is...
DEPRESSED ______________________________ BALANCED
I have negative thoughts...
OFTEN ______________________________ NEVER
I interact or socialize with others...
NEVER ______________________________ OFTEN
Friends or family tell me they see a change for the better...
NEVER ______________________________ OFTEN
VNS Therapy 3-month journal
Write down thoughts and experiences that relate to your answers.
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__________________________________________________
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Click the print button to print out a copy you can bring to your psychiatrist.
UNITED STATES INDICATION FOR USE:
The VNS Therapy System is indicated for use as an adjunctive therapy in
reducing the frequency of seizures in adults and adolescents over 12 years
of age with partial onset seizures, which are refractory to antiepileptic
medications.
VNS Therapy (or the VNS Therapy System) is indicated for the adjunctive
long-term treatment of chronic or recurrent depression for patients over
the age of 18 who are experiencing a major depressive episode and have not
had an adequate response to four or more adequate antidepressant treatments.
