Brain Changes After 15-Month Vagus Nerve Stimulation as Preventive Treatment of Severe and Highly Recurrent Treatment-Resistant Depression

We present a case of vagus nerve stimulation (VNS) in a patient with severe and highly recurrent treatment-resistant depression (TRD) supported by clinical and neuroimaging findings. The patient had a long-lasting diagnosis of bipolar I disorder, a stable polypharmacological regimen, multiple hospitalizations, and had undergone several ECT sessions. Despite achieving satisfactory clinical recovery, the patient was considered a suitable candidate for VNS implantation to prevent further episodes, maintain sustained clinical remission, minimize subthreshold symptoms, and improve quality of life, daily functioning, and overall engagement. After 15 months of follow-up, the patient exhibited increased participation in daily activities, reduced psychomotor retardation, and improved emotional well-being. At follow-up, psychometric scores confirmed clinical improvement and stability, including mood, anhedonia, and functioning, along with regional increases in white matter volume in the limbic and striatal regions.