Right-Sided Vagus Nerve Stimulation in Treatment-Resistant Mood Disorders with Cardiac Issues

Overview

This case series reports on three patients with treatment-resistant mood disorders and significant cardiac comorbidities who underwent right-sided vagus nerve stimulation (VNS). All patients experienced significant mood stabilization and reduced hospitalizations without serious cardiac adverse events over approximately 12 months of follow-up.

Background

Vagus nerve stimulation is an established treatment for treatment-resistant affective disorders, typically performed on the left cervical vagus nerve due to concerns about cardiac risks associated with right-sided stimulation. However, limited clinical data exist on right-sided VNS for psychiatric indications, despite potential benefits for patients with cardiac comorbidities or anatomical constraints. This series explores right-sided VNS as a viable alternative in such complex cases.

Data Highlights

Key Findings

• Right-sided VNS was chosen due to contraindications for left-sided implantation, including cardiac conduction abnormalities and anatomical constraints.
• All three patients showed significant and lasting mood stabilization within approximately 12 months post-implantation.
• Hospital admission rates markedly decreased following right-sided VNS treatment.
• Maintenance electroconvulsive therapy was discontinued or notably reduced in two patients.
• No clinically significant bradyarrhythmia, device interactions, or serious cardiac adverse events were observed during right-sided stimulation.
• Right-sided VNS was generally well tolerated with no serious complications reported.

Clinical Implications

Right-sided VNS can be a safe and effective alternative for patients with treatment-resistant mood disorders who have cardiac comorbidities or anatomical factors precluding left-sided implantation. Multidisciplinary evaluation is essential to assess risks and optimize patient selection. This approach may expand neuromodulation options for complex psychiatric patients while minimizing cardiac risks.

Conclusion

This case series supports the feasibility and clinical benefit of right-sided VNS in treatment-resistant mood disorders with cardiac complications, highlighting the need for further systematic research to establish long-term efficacy and safety in psychiatric populations.

References

1. Author/Source/Year -- Case Series: Right-Sided Vagus Nerve Stimulation in Patients with Treatment-Resistant Mood Disorders and Cardiac Complications