15. Vagal Nerve Stimulation in Treatment of Refractory Major Depression

  1. Sam Eljamel3 and
  2. Konstantin V. Slavin4
  1. Christine Matthews1,
  2. Serenella Tolomeo1 and
  3. Keith Matthews2

Published Online: 19 JUL 2013

DOI: 10.1002/9781118346396.ch15

Neurostimulation: Principles and Practice

Neurostimulation: Principles and Practice

How to Cite

Matthews, C., Tolomeo, S. and Matthews, K. (2013) Vagal Nerve Stimulation in Treatment of Refractory Major Depression, in Neurostimulation: Principles and Practice (eds S. Eljamel and K. V. Slavin), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118346396.ch15

Editor Information

  1. 3

    Centre for Neurosciences, Ninewells Hospital & Medical School, Dundee, Scotland, UK

  2. 4

    Department of Neurosurgery, University of Illinois at Chicago. Chicago, Illinois, USA

Author Information

  1. 1

    University of Dundee, Dundee, UK

  2. 2

    Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK

Publication History

  1. Published Online: 19 JUL 2013
  2. Published Print: 19 AUG 2013

ISBN Information

Print ISBN: 9781118346358

Online ISBN: 9781118346396



  • ablative neurosurgery;
  • electroconvulsive therapy;
  • major depressive disorder (MDD);
  • treatment of refractory major depression (TRMD);
  • vagal nerve stimulation (VNS)


Vagal nerve stimulation (VNS) for treatment of refractory major depression (TRMD) has been explored as an alternative to electroconvulsive therapy and ablative neurosurgery. VNS describes a procedure whereby the cervical portion of the left vagus nerve (VN) is stimulated electrically. A robust assessment of the “adequacy” of treatments (pharmacological, psychological, and ECT) must be conducted before a surgeon is approached to consider implantation of a VNS system. This chapter provides a list of measures, or suitable alternatives, which usually forms the core of a comprehensive assessment battery for patients with refractory major depression who are to be treated with VNS. VNS therapy has also been shown, using functional magnetic resonance imaging in major depressive disorder (MDD) patients, to be associated with ventromedial prefrontal cortex deactivation and activation of the right insular cortex. All patients should be kept under close clinical review and, where appropriate, clinical outcomes should be fully reported.