Effects of Vagus Nerve Stimulation (VNS) as a Treatment of Persistent Depression With Comorbid Personality Disorders (Impulse-VNS

Inclusion criteria * embedding criteria according to "VNS manual for doctors" * diagnosis of a recurrent depressive disorder (based on ICD-10 criteria) and a comorbid personality disorder (according to SKID I/II) with an ailment period of more than six months * age 18-80 years * verbal IQ (WST) 85 points * HAM-D sum score \> 20 points * at least four depressive episodes in the anamnesis * no amelioration of current depressive episodes under two different antidepressants in appropriate dosage for six weeks * constant medication within the last two weeks (at the discretion of the supervising doctor) * written consent after informing the patient about the study * no VNS treatment to date * no misuse of illegal drugs or alcohol * Women in childbearing age are not permitted to participate in the study if a doctor has asserted the non-existence of pregnancy before the beginning of the study. Furthermore, the procedure of a pregnancy test is recommended after the completion of the study. During the study, a reliable type of contraception (such as the Pill) should be taken. The doctor provides further information. Exclusion criteria according to "VNS manual for the doctor" * present hospitalisation according to the federal states' PsychKG * clinically relevant unstable bodily concomitant diseases * former VNS treatment * reduction of intelligence with verbal IQ \< 85 (WST) * conceivable use of an MRT examination after the implantation of the VNS-system * for diagnostic examinations with the dTMS and the MRT: electric devices (such as cardiac pacemakers, medicine pumps etc.) or pieces of metal (ferromagnetic, e.g. screws after bone fractures) within or at the body, or large-scale tattoos * conditions that do not allow to use VNS, such as relevant dysfunctions of the heart's stimulus conduction system or cardiac arrhythmia, stomach ulcer, dysphagia, palsy of parts of the n-vagus nerve * insufficient knowledge of the German language * pregnancy or lactation * current misuse of substances