In the 12-month RECOVER trial, 493 adults with highly treatment-resistant major depressive disorder were randomized to active vagus nerve stimulation (VNS) plus treatment as usual or sham VNS plus treatment as usual. Participants had failed an average of about 13 lifetime antidepressant treatments and had longstanding, severe illness. Active VNS did not significantly outperform sham on the primary endpoint-percent time in Montgomery-Åsberg Depression Rating Scale (MADRS) response (18.9% vs 16.3%; P = 0.137). However, several secondary measures favored active VNS, including greater time in response on the patient-rated Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR) and clinician-rated Clinical Global Impressions (CGI-I) and greater time in partial response on the Quick Inventory of Depressive Symptomatology - Clinician Rated (QIDS-C) and CGI-I.

For patients with marked treatment-resistant depression, the findings highlight both the potential and the limitations of VNS in a population with few remaining treatment options. Benefits were modest and varied depending on the outcome measure, while remission rates were low and did not differ significantly between groups on MADRS, QIDS-C, or QIDS-SR. The device was generally well tolerated, with no new safety signals identified, although dysphonia, dyspnea, implant-site pain, worsening depression, and suicidal ideation were among reported adverse events. The authors note that the extreme degree of treatment resistance, fixed stimulation parameters after early titration, and limitations of the sham design may have influenced the results. This underscores the need for longer-term follow-up and additional analyses.

Reference: Conway CR, Aaronson ST, Sackeim HA, et al. Vagus nerve stimulation in treatment-resistant depression: A one-year, randomized, sham-controlled trial. Brain Stimul. 2025 May-Jun;18(3):676-689. doi: 10.1016/j.brs.2024.12.1191. PMID: 39706521.

A multicenter cross-sectional study of 540 adolescents with depression across eight provinces in China examined how family cohesion and adaptability relate to depressive symptom severity. Greater cohesion and adaptability were associated with lower PHQ-9 scores, while adolescents from families characterized by low cohesion, rigid adaptability, or “extreme-type” family structures reported more severe symptoms. After adjustment for demographic factors, extreme-type family structure remained significantly associated with greater depressive symptom severity (β=0.26).

When caring for adolescents with depression, assessing family functioning, including emotional connectedness and how families adapt to stress or change, may provide useful context alongside individual symptom assessment. However, the cross-sectional design cannot establish that family dynamics cause or worsen depression. Generalizability also is limited by the clinical, convenience-sampled Chinese population and by unmeasured factors such as treatment status, comorbid conditions, family psychiatric history, and adverse childhood experiences.

Reference: Li JJ, Zhou BJ, Zhu JQ, et al. The impact of family cohesion and adaptability on depressive symptoms in adolescents with depression: a cross-sectional study in China. Sci Rep. 2026 Jul 30. doi: 10.1038/s41598-026-60532-8. 

The US Preventive Services Task Force (USPSTF) recommends screening all adults for major depressive disorder, including pregnant and postpartum patients and adults aged 65 years and older, concluding with moderate certainty that screening provides a moderate net benefit. Common tools include the PHQ-2 and PHQ-9 for adults, the Geriatric Depression Scale for older adults, and the Edinburgh Postnatal Depression Scale during pregnancy and postpartum. Positive screens should be followed by additional assessment to confirm the diagnosis, evaluate symptom severity, and identify comorbid conditions. The USPSTF does not specify an optimal screening interval, instead recommending clinical judgment based on prior screening, risk factors, comorbidities, and life events.

In practice, implementation matters as much as screening itself: practices should have systems in place to ensure positive screens lead to accurate diagnosis, evidence-based treatment, appropriate referral, and follow-up. By contrast, the USPSTF found insufficient evidence to determine whether routine screening for suicide risk in asymptomatic adults provides a net benefit, citing limited evidence on screening accuracy, clinical outcomes, and potential harms. This does not mean suicide risk should be ignored. Rather, the recommendation highlights an evidence gap around universal screening in otherwise asymptomatic primary care populations.

Reference: US Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023 Jun 20;329(23):2057-2067. doi: 10.1001/jama.2023.9297.