In the first instance, we would suggest reading some of the material available on the web. Useful places to start include:
www.vnstherapy.com - information about VNS therapy (most information is about epilepsy)
www.cyberonics.com - the website of the company who manufacture the device
No. All patients must be referred by their consultant psychiatrist. Unfortunately, referrals from GPs or other healthcare professionals are not accepted since a post-operative care plan needs to be in place.
Patients from Scotland can be assessed for VNS at no additional cost since it might just be one of a variety of options to be considered. However, if VNS is the preferred choice, funding will be required even for Scottish patients. We would suggest that psychiatrists look into the possibility of VNS being funded *before* referral since there may be significant delays in funding being approved.
For patients out with Scotland, VNS has to be funded by the patient's local NHS Trust. Before someone can be assessed, the NHS Trust will have to agree funding for assessment. Due to the relative expense of VNS, many NHS Trusts won't readily approve funding. Patients attending Dundee cannot self-fund for VNS.
More than most other treatments for depression! The overall cost has to take into account extensive pre-operative assessment by neuropsychologists, psychiatrists, and psychologists, as well as a period of inpatient stay in hospital. Follow-up is typically for 3-5 years, and patients have to attend Dundee regularly in the initial stages for programming of the device and optimisation of the stimulating parameters.
We conduct detailed assessments of all previous treatment approaches and review the patient, typically in Dundee. Thereafter, we advise on management options that should be explored. Only sometimes does this involve Vagus Nerve Stimulation and any assessment would be conducted on the basis that we would provide our overall clinical opinion rather than specifically focusing purely on Vagus Nerve Stimulation.
The number of previous treatments which should have been tried is not as high as for ablative neurosurgery. However, it is expected that the individual is demonstrably resistant to a variety of different classes of antidepressants (at least four), as well as having had a course of psychological treatment (e.g. CBT or IPT) which has been unsuccessful.
Although they are just a guide, there are criteria for suitability for VNS.
At this time, Vagus Nerve Stimulation should be considered as an experimental treatment. Although it shows promise, there is still relatively little information available about its overall effectiveness in the long term and when it might best be used. Some outcomes from published research are given on our general VNS page. It is important to remember that there is far more evidence for established treatments for depression such as antidepressants, cognitive behavioural therapy (CBT), and electroconvulsive therapy (ECT).
There is much less evidence to support VNS as a treatment for bipolar depression and it isn't clear what the role of VNS might be. We would encourage potential referrers to discuss it with us. Assessments will be conducted on a case-by-case basis.