Long-Term Outcome of Vagus Nerve Stimulation in Rapid-Cycling Bipolar Disorder

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Sir: The phenomenon of rapid cycling in patients with bipolar disorder has been identified as a marker for high risk of recurrence and resistance to conventional drug treatment.¹ New anticonvulsants are promising agents for the treatment of bipolar disorders, but they are heterogeneous with regard to their efficacy, target symptoms, and adverse event profiles.²

Vagus nerve stimulation (VNS) therapy is delivered with a device (NCP System; Cyberonics, Houston, Tex.) and has received U.S. Food and Drug Administration approval for adjunctive long-term treatment of chronic or recurrent depression for patients who are experiencing a major depressive episode and have not had an adequate response to 4 or more adequate antidepressant treatments.’ ‹