The fourth theory suggests that the stimulation causes synaptic depression by transmitter

depletion.172,173 Although depression is probably a disorder of multiple brain areas, neuronal pathways, neurotransmitters, and genomic systems, DBS requires stimulation of a single brain area. Many studies indicate that the limbic-cortical pathways and specifically the subgenual Inhibitors,research,lifescience,medical cingulate (Cg25) are involved in acute sadness and in the antidepressant effect of medications, electroconvulsive therapy, and transcranial magnetic stimulation.174-176 Therefore, this area was first tested by Mayberg and colleagues for the efficacy of DBS as a treatment for major depression. By using pretreatment and post-treatment PET scans, it was demonstrated that

the cerebral blood flow abnormalities related to depression, such as decreased blood flow in the prefrontal area and increased blood flow in the subgenual cingulate (Cg25), were normalized after DBS in the treatment-responsive Inhibitors,research,lifescience,medical patients.158 Vagus nerwe stimulation Development of VNS The vagus nerve, the longest of the cranial nerves, is a mixed nerve, with Inhibitors,research,lifescience,medical 80% of the fibers carrying afferent information (to the brain) and 20% of the fibers carrying efferent information (from the brain). Afferent sensory fibers within the vagus nerve terminate in the nucleus tractus solitarius (NTS), which innervates many brain regions that are related to selleck kinase inhibitor psychiatric disorders (for example, locus ceruleus, amygdala, and hypothalamus). The potential of vagal nerve stimulation to influence central nervous system function was demonstrated long before its use as a therapeutic intervention was considered.177,178 Inhibitors,research,lifescience,medical During the 1980s, Zabara showed that VNS has an anticonvulsant action in dogs179 Inhibitors,research,lifescience,medical and during the

1990s VNS became a treatment modality for epilepsy in humans.180,181 In 2000, VNS was found to be associated with mood improvements in patients with epilepsy.182,183 VNS has also been demonstrated to affect specific brain areas including the limbic system184 and to alter concentration of monoamines within the central nervous Electron transport chain system (such as serotonin, norepinephrine, GABA, and glutamate).185,186 These clinical and laboratory findings, together with the efficacy of anticonvulsant medications as a treatment for depressive episodes, has led to the hypothesis that VNS might be an effective treatment for major depression.187 Technique of VNS VNS is performed in humans by stimulation of the left cervical vagus nerve using a subcutaneous generator that sends an electrical signal to the nerve.188 The generator is implanted into the left chest wall Bipolar electrodes are wrapped around the left vagus in the neck through a special incision, and tunneled under the skin toward the chest.189 The stimulation parameters that can be adjusted by the physician include current intensity, pulse width, frequency, and duration of the on and off periods.