To the Editor: Major depression is one of the most common ailments, affecting about 18 million people in the United States. According to various sources, from 15% to 33% of major-depression patients do not respond to at least one or more adequate treatment regimens.1,2 Treatment-resistant depression (TRD) is one of the most difficult problems encountered by clinicians. In 2005, vagus nerve stimulation (VNS) was approved by the U.S. Food and Drug Administration for patients with chronic or recurrent depression who failed to respond to at least four antidepressant interventions. Although clinical trials have been done on the efficacy of VNS on TRD patients,3–8 the long-term effects of VNS have rarely been reported. Here, we report a case of severe TRD with VNS treatment for 6 years, showing its good tolerability and efficacy in this patient.