Vagus nerve stimulation

Our rating
 Question mark: This treatment has not been properly researched. It is not possible to say whether they are useful or not.

What is it?

Vagus nerve stimulation (VNS) is a medical treatment where a device similar to a pacemaker is implanted into the chest. A wire leading out of the device is passed under the skin and connected to the left vagus nerve in the neck. This nerve is connected to the brain. VNS involves periodically stimulating this nerve with electrical signals. VNS is an approved treatment for depression which does not respond well to other forms of treatment. VNS is more commonly used to treat other disorders such as epilepsy. 

How does it work?

It is not clear exactly how VNS might help treat depression. The vagus nerve is connected to brain areas involved in mood regulation. Stimulating this nerve might help restore chemical imbalances involved in depression.

Is it effective?

Only one randomized controlled trial has been conducted on VNS for people with diagnosed depression. Participants in this study who received VNS did not experience any greater reduction in their depression symptoms than those who received a placebo (dummy) treatment.

Many more studies have been conducted where the treatment was not compared to a placebo. In these studies, more people experienced a reduction in depression symptoms if they had the VNS treatment compared to people who had only their regular treatment (for example, antidepressant medication).  However, because there was no placebo group to compare to in these studies, we cannot be sure that the VNS intervention caused this effect.

Are there any disadvantages?

VNS is an invasive procedure and requires surgery under general anesthetic to implant the device. It is also an expensive procedure which may not be covered by Medicare.

It may be many months before an improvement in symptoms is noticed. Side effects can include neck pain, voice changes, coughing, headaches and chest pain, amongst others.

Where do you get it?

VNS is only available for people whose depression has not responded to conventional treatment. A referral to a specialist doctor is required.

Recommendation

There is not enough good evidence at this stage to recommend vagus nerve stimulation as a treatment for depression.

Key references

  • Berry, S. M., Broglio, K., Bunker, M., Jayewardene, A., Olin, B., & Rush, A. J. (2013). A patient-level meta-analysis of studies evaluating vagus nerve stimulation therapy for treatment-resistant depression. Med Devices (Auckl), 6, 17-35.
  • Martin, J. L., & Martin-Sanchez, E. (2012). Systematic review and meta-analysis of vagus nerve stimulation in the treatment of depression: variable results based on study designs. Eur Psychiatry, 27(3), 147-155.

Last reviewed and updated: 1 December 2016