Vagusstimulation. Eine neue Behandlungsoption für chronifizierte depressive Erkrankungen

Zusammenfassung

Die Vagusnerv-Stimulation (VNS) wird seit den 90er Jahren mit Erfolg zur Behandlung der therapieresistenten Epilepsie eingesetzt. Vor kurzem veröffentlichte Daten aus offenen Akut- sowie Langzeit-Studien haben gezeigt, dass VNS auch als antidepressive Therapie von Nutzen sein kann. Dies gilt vor allem für bis dahin therapierefraktäre Depressionen. Erste Theorien zur Wirksamkeit weisen auf neuroanatomische Verbindungen des Vagusnervs zum limbischen Systems und zu anderen Hirnstrukturen hin, die mit affektiven Störungen in Zusammenhang gebracht werden. In positronenemissions-tomographischen (PET) Untersuchungen konnten unter VNS in wesentlichen limbischen Strukturen Funktionsänderungen nachgewiesen werden. Derzeit laufen mehrere Studien zur Frage, warum VNS bei affektiven Störungen wirksam ist, welches die primären Indikationen sein sollten und zum Beleg der Wirksamkeit.

Abstract

Vagus Nerve Stimulation (VNS) is since the 1990 a clinically useful anticonvulsant therapy for treatment-resistant epilepsy. Open acute and longer term data suggest the potential clinical utility of VNS as an antidepressant therapy especially in treatment refractory depression. The vagus nerve has connections to the limbic system and other brain structures which modulate affect. PET studies showed functional changes under VNS in such critical areas, which can explain the mechanisms of action of VMS. Ongoing studies will have to better establish its acute and longer-term efficacy, and specific indications in the treatment of depression.

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