Vagus nerve stimulation (VNS) is a medical procedure where a device (either implanted or non-implanted) sends mild electrical pulses to the vagus nerve in the neck to treat conditions such as epilepsy, depression, and aid in stroke rehabilitation by altering brain activity.
The term “vagus nerve stimulation” is also used broadly in health and wellness circles to highlight non-invasive, polyvagal-informed approaches to support stimulation of the vagus nerve, such as singing, humming, massage, and drumming, in helping symptoms of mental health challenges such as depression.
All types of VNS for depression share the same goal of promoting relaxation, improving mood, regulating emotions, lowering heart rate and blood pressure, and improving overall well-being.
Read on to learn more about what vagus nerve stimulation is and how new research on its effectiveness can offer hope to those with severe cases of treatment-resistant depression.
What Is the Vagus Nerve?
The vagus nerve is one of 12 pairs of cranial nerves located on each side of the body that send electrical signals between the brain, neck, and abdomen. It is the longest cranial nerve in the body, running from the brain stem down through the chest and stomach to the colon.
It consists of hundreds of thousands of sensory fibers that provide information from organs to the brain, as well as motor fibers, which control functions such as heart rate, digestion, and speech [1].
The nerve plays an essential role in the gut-brain axis, a communication pathway that links the brain and digestive system, influencing mental health and body functions through nervous system regulation.
Our vagal tone is the level of activity and influence the vagus nerve exerts on the body, particularly on the parasympathetic regulation of the heart and other organs. Vagal tone is an important part of vagus nerve stimulation and treating health conditions such as depression because increased vagal activity is associated with better emotional regulation, decreased stress response, and improved resilience to mental health disorders [2].
What Is Vagus Nerve Stimulation?
The use of VNS is limited, most commonly in those with severe cases of epilepsy, and as a rehabilitation aid for patients who have suffered a stroke. But it is growing in its effectiveness for treatment-resistant depression.
Types of Vagus Nerve Stimulation
There are two approved types of VNS stimulation devices: implantable medical devices and non-implantable VNS devices [3].
Implantable VNS Devices
This method involves implanting a device in the back of the neck or chest. It sends programmed electrical impulses through a wire electrode via the vagus nerve to the brainstem and other regions of the brain. It is sometimes called a “pacemaker for the brain” and is not shock therapy!
Standard VNS devices often have programmable stimulation cycles. Some devices have advanced programmable features, such as autostimulation based on heart rate and breathing.
Non-Implantable VNS Devices
These devices stimulate the vagus nerve without surgery, usually through the skin or the ear. These typically look like neck thermometers, earbuds, or neck collars.
Non-invasive devices are more ideal in treating depression for their ease of use, lack of surgery, and flexibility. Implantable devices often provide more consistent stimulation for severe conditions like epilepsy.
What Conditions Does Vagus Nerve Stimulation (VNS) Treat?
The FDA has approved medical vagus nerve stimulation (VNS) for three primary conditions:
- Epilepsy: VNS is approved as an add-on therapy for partial seizures in adults and kids 4 years and older who have not been able to have their seizures controlled by medication [4].
- Stroke rehabilitation: VNS is approved as a rehab aid for people who have moderate to severe loss of arm and hand function after a stroke [5].
- Depression: VNS is approved in adults 18 and older who have chronic, recurrent depression and have not responded to four or more antidepressant treatments (medication and therapy).
How Does Vagus Nerve Stimulation Work for Depression?
VNS for depression works by sending mild electrical pulses to the left vagus nerve. The left vagus nerve acts as a primary communication pathway between the brain and gut, playing an important role in regulating mental health symptoms.
The stimulation of the left vagus nerve modulates brain activity in areas linked to mood regulation, helping reduce depressive symptoms gradually over time, typically showing effects after several months [6].
VNS is not a first line of treatment for depression and typically is only eligible for adults who have tried at least four different antidepressant medications, psychotherapy (such as CBT), and advanced treatments such as TMS or ketamine therapy.
Charles R. Conway, MD, a professor of psychiatry at Washington University Medicine summarizes a case example illustrating this, “These patients are extremely ill, and most have been for a very long time, on average, each patient had already tried 13 treatments that failed to help them before they enrolled in the trial, and they had spent more than half of their lives sick with depression” [7].
Effectiveness of Vagus Nerve Stimulation for Depression
In a major study led by Washington University School of Medicine, results showed that vagus nerve stimulation (VNS) therapy significantly improves symptoms, quality of life, and daily functioning in people with severe, treatment-resistant depression who have failed several other advanced treatments.
In the research, nearly 500 participants received implantable VNS devices connected to their left vagus nerve, with half having active stimulation for 12 months. Despite patients’ long histories of depression and multiple failed treatments, those with active VNS therapy spent more time with symptom relief and reported meaningful functional improvements compared to those without active stimulation [7].
Polyvagal-Informed Activities To Stimulate The Vagus Nerve
Polyvagal-informed therapy is a therapeutic approach based on Polyvagal Theory, developed by Dr. Stephen Porges, which focuses on the role of the vagus nerve in regulating the autonomic nervous system and how it influences our emotional and physiological responses to stress and trauma.
Polyvagal-informed somatic practices and wellness activities can help stimulate the vagus nerve, regulate nerve cell activity, and reduce symptoms of mental health challenges such as depression or anxiety.
Singing or Humming
Vocal activities like singing or humming target the auricular branch of the vagus nerve via the vocal cords, located in the ear and around the throat. Studies indicate that humming, in particular, increases vagal activity by engaging the muscles and tissues connected to the nerve [8].
Massage Therapy
Certain forms of massage, such as myofascial release around the neck and shoulders, stimulate the vagus nerve mechanically. Clinical trials have also shown that cranial massage (scalp, head, and neck) can increase vagal tone and improve mood states by reducing cortisol and sympathetic activity [8].
Drumming
Research rooted in polyvagal theory shows that rhythmic drumming can activate the ventral vagal complex and physiological functions such as heart rate and stress response.
Low-frequency rhythms, especially bass notes, can support emotional regulation by activating the vagal “brake,” which reduces the sympathetic fight-or-flight response, to decrease anxiety and improve mood [9].
Cold Plunge Therapy
Exposure to cold water activates the vagus nerve through the “mammalian diving reflex”, which triggers the parasympathetic responses that slow the heart rate and lower blood pressure [10].
Advanced Treatments in Utah for Chronic Depression
Discover the power of Vagus Nerve Stimulation at Maple Mountain Mental Health and Wellness in Utah, where advanced neuromodulation treatments blend cutting-edge technology with integrated wellness.
Our comprehensive approach includes non-invasive vagus nerve stimulation, ketamine therapy, TMS, and supportive activities such as yoga, massage, and breathwork, all designed to strengthen vagal tone and reinforce the brain-body connection.
Reach out to our admissions team today and start your journey to inner peace with expert guidance tailored to your unique needs.
Sources
[1] Mayo Clinic. nd. Vagus Nerve Stimulation.
[2] Massachusetts General Hospital. nd. Vagus Nerve.
[3] Silberstein, S. (2015). Surgically implanted and non-invasive vagus nerve stimulation: a review of efficacy, safety and tolerability. European journal of neurology, 22(9), 1260–1268.
[4] Englot, D. et al. 2019. Vagus Nerve Stimulation for the Treatment of Epilepsy. Neurosurgery clinics of North America, 30(2), 219–230.
[5] Sather, M. 2024. Breakthrough stroke treatment at Penn State Health offers patients new hope. Penn State University.
[6] Carreno, F. et al. 2017. Vagal Nerve Stimulation for Treatment-Resistant Depression. Journal of Neurotherapeutics.
[7] Schneider, T. 2024. Vagus nerve stimulation relieves severe depression. Washington University Medicine.
[8] Tanaka, S. (2022). Clinical perspectives on vagus nerve stimulation: present and future. Clinical science (London, England: 1979), 136(9), 695–709.
[9] Hoggle, J. et al. 2022. POLYVAGAL-INFORMED THERAPEUTIC DRUMMING FOR VICTIMS OF INTERPERSONAL VIOLENCE: A FEASIBILITY STUDY. University of Alabama.
[10] Bhaskar, K. et al. 2025. Autonomic Effects of Facial Immersion at Varying Water Temperatures: A Comparative Study Across Two Age Groups. European Journal of Cardiovascular Medicine.