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More than you wanted to know about the vagus nerve!
A news report from Reuters Health News ran today on Medscape Psychiatry entitled “Vagal Stimulator May Yet Show Promise for Depression.” This treatment has been used in Europe and approved for the treatment of epilepsy in the US. According to the Reuters report “medical device maker Cyberonics Inc. said on Tuesday that a trial of its vagus nerve stimulator to treat acute depression had shown promise.” Yet, while the manufacturer claims that 'the stopwatch-sized device' used for the treatment of epilepsy, they said a major 1-year trial of the device in patients with acute depression showed statistically and clinically significant improvements,” they continue to point out, however, that “the company said it has yet to prove a causal link between the device and improvement in patients' condition.”
Those are really interesting contrasting points. Perhaps it was the way the Reuters article was written but it set off my alarms. It also reminded me that this is not just a simple external device like a muscle stimulator. This is serious surgery.
If you are curious about what is involved read this:
Placement of a vagal stimulator is done with the patient under general anesthesia. The patient is placed in the supine position. The hair over the neck or chest incisions is shaved. The neck incision is made along the anterior border of the sternocleidomastoid muscle about halfway between the mastoid process (the bony prominence low and behind the ear) and the clavicle (breast bone) where it ends at the junction of the chest and neck. The chest incision is variable: the simplest is a straight line incision parallel to the clavicle about half way between this bone and the nipple. For cosmetic or other considerations the surgeon and patient may elect to put the incision (and therefore the generator as well) in a different location.
A metal tube with blunt end is used to open a "tunnel" 
in the space below the skin and above the muscle fascia
of the neck and chest. After the electrodes are placed the wires that will connect it to the generator are fed through the tunnel. A "pocket" large enough to accomodate the electrical generator (approximately 4 by 4 by 2 inches, 1/4 pound) is made and the generator is "interrogated" by a computer (used later in the outpatient clinic to make adjustments) prior to placement in the pocket.
Both incisions are closed with sutures to the deep tissue layers, staplels, tape, or glue can be used to close the skin. The patient is taken to the recovery room post operatively and can usually go home the next day.
The postoperative complications can also be quite serious.
Perhaps for uncontrolled seizures, this could be a blessing but I believe that we have many more choices for depression, even treatment resistant depression. Let see how the studies progress and weigh the evidence.
To access:
1) The Medscape Reuters News Report (registration is free but required)
2) More information than you ever wanted to know about vagal stimulation from USC Neurosurgery in Los Angeles
10:57:44 PM 
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