I noticed that you’re still talking about and referring to “treatment resistant depression” when in fact CMS (Centers for Medicare and Medicaid Services), across the pond here in the U.S., denied insurance reimbursement for VNS Therapy as there is no such medical term as “treatment resistant depression” as indicated in their decision of May 4, 2007.

“Vagus nerve stimulation is not covered for treatment resistant depression…”

“These various indications that have been proposed for VNS illustrate that the term”treatment resistant depression” lacks a standard definition that has been scientifically validated, and appears to be subject to various interpretations. The National Clinical Practice Guideline for Depression in Primary and Secondary Care (2004) states an important point: “The term ‘refractory depression’, used to describe depression that has failed to respond to two or more antidepressants at an adequate dose for an adequate duration given sequentially, is not especially helpful. It does not take into account depressive subtypes, makes no distinction between treatment resistance, chronicity, relapse or recurrence, and fails to take into account what psychosocial factors may be preventing recovery or indeed whether the patient has had an adequate course of an appropriate psychotherapeutic treatment (Andrews & Jenkins, 1999)”.

http://www.vnsdepression.com/pp10-010173-articles_5-4-07-CMS-Kills-Any-Hope-For-VNS.htm

They recognize MDD (Major Depressive Disorder) and long-term treatment of chronic or recurrent depression but not TRD. It is also interesting to note that rTMS, recently FDA approved here in the U.S., and the ongoing DBS studies for depression do not refer to TRD. I guess they’re wise enough to have learned from the VNS fiasco.

Warmly,
Herb
VNSdepression.com