Vagus Nerve Stimulation (VNS)

Vagus Nerve Stimulation (VNS) is an FDA-approved neuromodulation treatment for treatment-resistant depression (TRD) in adults who have not responded adequately to multiple standard therapies. VNS involves chronic, intermittent electrical stimulation of the left vagus nerve via an implanted device to modulate brain circuits involved in mood regulation.

VNS is distinct from other interventional treatments in that it is designed to provide long-term neuromodulation, with antidepressant benefits that often emerge gradually over months and may increase over time. It is particularly considered for individuals with chronic, highly treatment-resistant illnesses.

At the UTHealth Houston Center for Interventional Psychiatry, VNS is offered within a specialized, multidisciplinary framework that integrates surgical collaboration, psychiatric expertise, and longitudinal follow-up.

Who May Be Appropriate for VNS

VNS may be considered for patients who:

  • Have chronic treatment-resistant depression
  • Have not responded adequately to multiple antidepressant medications, psychotherapy, and other interventional treatments
  • Have experienced recurrent or persistent depressive episodes over many years
  • Can engage in long-term follow-up and monitoring
  • Are appropriate candidates for a surgically implanted device

All patients undergo a comprehensive psychiatric evaluation and medical assessment to determine candidacy for VNS therapy.

Treatment Process

VNS therapy involves:

  • Surgical implantation of a pulse generator in the chest with a lead connected to the left vagus nerve in the neck
  • Postoperative recovery followed by device activation and programming
  • Gradual adjustment of stimulation parameters over time to optimize clinical response and tolerability

Once activated, the device delivers intermittent electrical stimulation automatically throughout the day. Patients do not feel continuous stimulation, though transient sensations may occur during stimulation cycles.

Expected Benefits and Timeline

Unlike rapid-acting treatments such as ketamine or ECT, the antidepressant effects of VNS typically:

  • Develop gradually, often over several months
  • May continue to improve with long-term stimulation
  • Are associated with sustained benefit and reduced relapse in selected patients

Because of this delayed onset, VNS is often used as part of a long-term treatment strategy rather than for acute symptom relief.

Safety and Monitoring

VNS is generally well tolerated. Common side effects may include:

  • Hoarseness or voice changes during stimulation
  • Throat or neck sensations
  • Cough or mild discomfort

These effects often diminish with time or can be managed through device reprogramming. Patients are monitored regularly to assess symptom response, side effects, and device function.

Integration With Ongoing Care

VNS therapy is integrated with:

  • Ongoing psychiatric care and medication management
  • Psychotherapy, when indicated
  • Regular follow-up visits for device programming and outcome monitoring

Through careful patient selection and long-term management, the Center aims to provide VNS as a durable treatment option for individuals with the most refractory forms of depression.