Alternative Treatment for Depression – Vagus Nerve Stimulation (VNS)

Did you know in Germany Vagus Nerve Stimulation can be used to treat depression, where indicated, and it’s even covered by German Health Insurance Funds? 

VNS is an approved, effective, well-tolerated, long-term therapy for chronic and therapy-resistant depression.  Dr Christine Reif-Leonhardt, MD, and her team of researchers from the University Hospital Frankfurt has recently published a journal article about the use of VNS in depression. In contrast to more common treatments for depression like anti-depressants, psychotherapy and ECT, VNS is little known in the general population and among specialists.

Available Since 1994

Initially VNS was used to treat severe cases of epilepsy in children. In Australia VNS is currently used in The Royal Children’s Hospital in Melbourne.

As is noted in Dr Reif-Leonhardt journal article, invasive VNS was approved in the European Union in 1994 and in the United States in 1997 for the treatment of children with medicinal therapy–refractory epilepsy. Because positive and lasting effects on mood could be seen in adults after around 3 months of VNS, irrespective of the effectiveness of anticonvulsive medication, "a genuinely antidepressant effect of VNS [was] postulated," and therefore it was further developed as an antidepressant therapy.

A VNS system first received a CE certification in 2001 in the European Union for the treatment of patients with chronic or relapsing depression who had therapy-resistant depression or who were intolerant of the current depression therapy. In 2005, VNS was approved in the US for the treatment of patients aged 18 years or older with therapy-resistant major depression for which at least four antidepressant therapies had not helped sufficiently.

Few Sham-Controlled Studies

According to Reif-Leonhardt and her colleagues, there have been multiple studies and case series on VNS in patients with therapy-resistant depression in the past 20 years. Many of the studies highlighted the additional benefits of VNS as a combined procedure, but they were observational studies. Sham-controlled studies (where some patients are given the treatment and others are not) are in short supply because of methodologic difficulties and ethical problems.

The largest long-term study is a registry study in which 494 patients with therapy-resistant depression received the combination of the usual antidepressant therapy and VNS. The study lasted 5 years; 301 patients served as a control group and received the usual therapy. The cumulative response to the therapy (68% vs 41%) and the remission rate (43% vs 26%) were significantly greater in the group that received VNS, according to the authors. Patients who underwent at least one ECT series of at least seven sessions responded particularly well to VNS. The combined therapy was also more effective in ECT non-responders than the usual therapy alone.

To date, only one sham-controlled study of VNS treatment for therapy-resistant depression has been conducted. In it, VNS was not significantly superior to a sham stimulation over an observation period of 10 weeks. However, observational studies have provided evidence that the antidepressant effect of VNS only develops after at least 12 months of treatment. According to Reif-Leonhardt and her colleagues, the data indicate that differences in response rate and therapy effect can only be observed in the longer term after 3 to 12 months and that as the therapy duration increases, so do the effects of VNS. From this, it can be assumed "that the VNS mechanism of action can be attributed to neuroplastic and adaptive phenomena," say the authors.


History of Vagus Nerve Stimulation

The first VNS device was implanted in 1988 in the United States of America. Regulatory approval as an adjunct therapy in reducing seizure frequency was granted in 1994 in Europe and 1997 in USA. The first implant in Australia was in 1994 and regulatory approval by the Therapeutic Goods Administration (Australia) was granted in April 2000.  VNS devices have been implanted in patients for over 25 years. More than 125,000 patients globally have been implanted with VNS devices. In Australia, more than 750 patients have been implanted.


Criteria for VNS Therapy

When should VNS be considered? The authors specify the following criteria:

  • An insufficient response to at least two antidepressants from different substance classes at a sufficient dosage and duration, as well as to two augmentation agents (such as lithium and quetiapine) in combination with guideline psychotherapy
  • Intolerable side effects from pharmacotherapy or contraindications to medicinal therapy
  • For patients who respond to ECT, the occurrence of relapses or residual symptoms after cessation of (maintenance) ECT, intolerable ECT side effects, or the need for maintenance ECT
  • Repeated or long hospital treatments due to depression


What are the other ways to stimulate Vagus Nerve?

Vagal Tone is the inhibitory control of your vagus nerve over your heart rate.  Here are some ways to improve your vagal tone and address symptoms of depression.

  • Deep breathing using your diaphragm
  • Humming
  • Speaking, singing and laughing regularly
  • Washing the face in cold water, ocean swimming. AS the body adjusts to heat and cold the fight or flight system (para sympathetic nervous system) will down regulate naturally.
  • Yoga
  • Meditation
  • Gut Health

Link to Dr Rief-Leonhard research is here