Prognostic and Prescriptive Predictors of Treatment Response to Adjunctive VNS Therapy in Major Depressive Disorder
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Le résumé fourni par la source
Vagus nerve stimulation (VNS) therapy is a long-term intervention for treatment-resistant major depression (TRD) adjunctive to treatment as usual (TAU). To enhance clinical decision- making, we identified subgroups that respond especially well or poorly with active VNS vs no stimulation sham VNS (prognostic predictors) and subgroups that specifically benefit from active VNS vs sham VNS (prescriptive predictors). In the RECOVER trial, patients with marked TRD (N=493) were randomized to either active VNS (N=249) or sham VNS (N=244); both groups continued TAU. Baseline demographic, clinical, and treatment history characteristics were evaluated as potential prognostic and/or prescriptive outcome predictors. Outcome assessment was based on a tripartite measure that combined depressive symptoms (Quick Inventory of Depressive Symptomatology-Clinician), psychosocial function (Work Productivity and Activity Impairment Questionnaire item 6), and quality of life (Mini-Quality of Life Enjoyment and Satisfaction Questionnaire). Generalized linear mixed models were employed to identify both prognostic and prescriptive predictors of tripartite outcomes. Several baseline features predicted outcomes across the entire sample and within the sham VNS group (prognostic prediction). History of treatment with electroconvulsive therapy (ECT; lifetime and current episode) or transcranial magnetic stimulation (TMS; current episode) was associated with poorer prognosis. However, these same features were associated with greater benefit from active VNS vs sham VNS. The presence of comorbid anxiety disorders was predictive of a better prognosis overall, but smaller benefit from active VNS vs sham VNS. Marked TRD patients with a history of ECT or TMS had especially poorer outcomes when receiving sham VNS plus TAU for 1 year than those without this history. These same subgroups showed significant differential benefit with active VNS than with sham VNS (positive prescriptive effect). The absence of a comorbid anxiety disorder was linked to superior benefit from active VNS vs sham VNS. These predictors may inform clinical decision-making when considering VNS. ClinicalTrials.gov identifier: NCT03887715.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Prognostic and Prescriptive Predictors of Treatment Response to Adjunctive VNS Therapy in Major Depressive Disorder
- Date Crossref
- 14/07/2025
- Éditeur
- Physicians Postgraduate Press, Inc
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Sheppard Pratt Health System pays non établi dans la noticeÉtablissement de santé
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Washington University in St. Louis Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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LivaNova (United Kingdom) pays non établi dans la noticeEntreprise
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Medical University of South Carolina Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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Ralph H. Johnson VA Medical Center pays non établi dans la noticeÉtablissement de santé
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Rush University Medical Center Department of Psychiatry and Behavioral Sciences pays non établi dans la noticeÉtablissement de santé
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Psychiatric Medicine Associates pays non établi dans la noticeÉtablissement de santé
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Emory University Department of Psychiatry and Behavioral Sciences pays non établi dans la noticeUniversité ou école supérieure
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University of Washington Department of Psychiatry and Behavioral Sciences pays non établi dans la noticeUniversité ou école supérieure
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Center for Anxiety and Depression pays non établi dans la noticeÉtablissement de santé
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University of Alabama at Birmingham pays non établi dans la noticeUniversité ou école supérieure
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Augusta University Department of Psychiatry and Health Behavior pays non établi dans la noticeUniversité ou école supérieure
Sheppard Pratt Health System, Department of Psychiatry — Washington University in St. Louis et LivaNova (United Kingdom), avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.