Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste.
Method:
Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering).
Results:
Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation.
Conclusions:
This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.
OgdenCLCarrollMDCurtinLRMcDowellMATabakCJFlegalKM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006; 295 (13): 1549–55.
2.
MokdadAHFordESBowmanBADietzWHVinicorFBalesVSMarksJS. Prevalence of obesity, diabetes, and obesity related health risk factors, 2001. JAMA. 2003; 289 (1): 76–9.
3.
FitzgibbonMLStolleyMRKirschenbaumDS. Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychol. 1993; 12 (5): 342–5.
4.
McElroySLKotwalRMalhotraSNelsonEBKeckPENemeroffCB. Are mood disorders and obesity related?. A review for the mental health professional. J Clin Psychiatry. 2004; 65 (5): 634–51.
5.
SimonGEVon KorffMSaundersKMigliorettiDLCranePKvan BelleGKesslerRC. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006; 63 (7): 824–30.
6.
PagotoSLBodenlosJSKantorLGitkindMMaY. Association of major depression and binge eating disorder on weight loss in a hospital-based weight loss program. Obesity Research. In Press 2007.
7.
BornsteinSRSchuppeniesAWongMLLicinioJ. Approaching the shared biology of obesity and depression: the stress axis as the locus of gene-environment interactions. Mol Psychiatry. 2006; 11 (10): 892–902.
8.
Kampov-PolevoyABAltermanAKhalitovEGarbuttJC. Sweet preference predicts mood altering effect of and impaired control over eating sweet foods. Eat Behav. 2006; 7 (3): 181–7.
9.
MachtMGererJEllgringH. Emotions in overweight and normal-weight women immediately after eating foods differing in energy. Physiol Behav. 2003; 80 (2–3): 367–74.
10.
GibsonEL. Emotional influences on food choice: sensory, physiological and psychological pathways. Physiol Behav. 2006; 89 (1): 53–61.
11.
ThayerRE. Calm energy: How people regulate mood with food and exercise. New York: Oxford University Press; 2001.
12.
ArnowBKenardyJAgrasWS. The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord. 1995; 18 (1): 79–90.
13.
DrewnowskiAKurthCHolden-WiltseJSaariJ. Food preferences in human obesity: carbohydrates versus fats. Appetite. 1992; 18 (3): 207–21.
14.
ChristensenLBrooksA. Changing food preference as a function of mood. J Psychol. 2006; 140 (4): 293–306.
15.
BentonDDonohoeRT. The effects of nutrients on mood. Public Health Nutr. 1999; 2 (3A): 403–9.
MachtMDettmerD. Everyday mood and emotions after eating a chocolate bar or an apple. Appetite. 2006; 46 (3): 332–6.
18.
MaulerBIHammAOWeikeAITuschen-CaffierB. Affect regulation and food intake in bulimia nervosa: emotional responding to food cues after deprivation and subsequent eating. J Abnorm Psychol. 2006; 115 (3): 567–79.
19.
WangGJYangJVolkowNDTelangFMaYZhuWWongCTTomasiDThanosPKFowlerJS. Gastric stimulation in obese subjects activates the hippocampus and other regions involved in brain reward circuitry. Proc Natl Acad Sci U S A2006; 103 (42): 15641–5.
20.
GeorgeMSSackeimHARushAJMarangellLBNahasZHusainMMLisanbySBurtTGoldmanJBallengerJC. Vagus nerve stimulation: a new tool for brain research and therapy. Biol Psychiatry. 2000; 47 (4): 287–95.
LomarevMDenslowSNahasZChaeJHGeorgeMSBohningDE. Vagus nerve stimulation (VNS) synchronized BOLD fMRI suggests that VNS in depressed adults has frequency/dose dependent effects. J Psychiatr Res. 2002; 36 (4): 219–27.
25.
MuQBohningDENahasZWalkerJAndersonBJohnsonKADenslowSLomarevMMoghadamPChaeJHGeorgeMS. Acute vagus nerve stimulation using different pulse widths produces varying brain effects. Biol Psychiatry. 2004; 55 (8): 816–25.
26.
PetersJHSimaskoSMRitterRC. Modulation of vagal afferent excitation and reduction of food intake by leptin and cholecystokinin. Physiol Behav. 2006; 89 (4): 477–85.
27.
RitterRC. Gastrointestinal mechanisms of satiation for food. Physiol Behav. 2004; 81 (2): 249–73.
28.
NahasZTenebackCChaeJHMuQMolnarCKozelFAWalkerJAndersonBKoolaJKoseSLomarevMBohningDEGeorgeMS. Serial vagus nerve stimulation functional MRI in treatment-resistant depression. Neuropsychopharmacology. 2007; 32 (8): 1649–60.
29.
CigainaV. Gastric pacing as therapy for morbid obesity: preliminary results. Obes Surg. 2002; 12Suppl 1: 12S–6S.
30.
RoslinMKurianM. The use of electrical stimulation of the vagus nerve to treat morbid obesity. Epilepsy Behav. 2001; 2: S11–S6.
31.
TecomaESIraguiVJ. Vagus nerve stimulation use and effect in epilepsy: what have we learned?. Epilepsy Behav. 2006; 8 (1): 127–36.
32.
UthmanBM. Vagus nerve stimulation for seizures. Arch Med Res. 2000; 31 (3): 300–3.
33.
HardenCLLazarLMPickLHNikolovBGoldsteinMACarsonDRavdinLDKocsisJHLabarDR. A beneficial effect on mood in partial epilepsy patients treated with gabapentin. Epilepsia. 1999; 40 (8): 1129–34.
34.
GeorgeMSSackeimHAMarangellLBHusainMMNahasZLisanbySHBallengerJCRushAJ. Vagus nerve stimulation. A potential therapy for resistant depression?. Psychiatr Clin North Am. 2000; 23 (4): 757–83.
35.
RushAJGeorgeMSSackeimHAMarangellLBHusainMMGillerCNahasZHainesSSimpsonRKGoodmanR. Vagus nerve stimulation (VNS) for treatment-resistant depressions: a multicenter study. Biol Psychiatry. 2000; 47 (4): 276–86.
36.
RushAJSackeimHAMarangellLBGeorgeMSBrannanSKDavisSMLavoriPHowlandRKlingMARittbergBCarpenterLNinanPMorenoFSchwartzTConwayCBurkeMBarryJJ. Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005; 58 (5): 355–63.
37.
RushAJMarangellLBSackeimHAGeorgeMSBrannanSKDavisSMHowlandRKlingMARittbergBRBurkeWJRapaportMHZajeckaJNierenbergAAHusainMMGinsbergDCookeRG. Vagus nerve stimulation for treatment-resistant depression: a randomized, controlled acute phase trial. Biol Psychiatry. 2005; 58 (5): 347–54.
38.
SackeimHARushAJGeorgeMSMarangellLBHusainMMNahasZJohnsonCRSeidmanSGillerCHainesSSimpsonRKGoodmanRR. Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology. 2001; 25 (5): 713–28.
39.
BurneoJGFaughtEKnowltonRMorawetzRKuznieckyR. Weight loss associated with vagus nerve stimulation. Neurology. 2002; 59 (3): 463–4.
40.
BodenlosJSKoseSBorckardtJJNahasZShawDO'NeilPMGeorgeMS. Vagus nerve stimulation acutely alters food craving in adults with depression. Appetite. 2007; 48 (2): 145–53.
41.
LangP. J.BradleyM. M.CuthbertB. N.International affective picture system (IAPS): Instruction manual and affective ratings. Gainesville (FL): University of Florida; 2005.
42.
BeckATSteerRABallRRanieriW. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996; 67 (3): 588–97.
43.
WhismanMAPerezJERamelW. Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) in a student sample. J Clin Psychol. 2000; 56 (4): 545–51.
BoothDA. Psychology of nutrition. London: Taylor & Francis; 1994.
46.
WurtmanJJ. Carbohydrate cravings: a disorder of food intake and mood. Clin Neuropharmacol. 1988; 11Suppl 1: S139–45.
47.
WurtmanRJWurtmanJJ. Do carbohydrates affect food intake via neurotransmitter activity?. Appetite. 1988; 11Suppl 1: 42–7.
48.
KorenMSHolmesMD. Vagus nerve stimulation does not lead to significant changes in body weight in patients with epilepsy. Epilepsy Behav. 2006; 8 (1): 246–9.
