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Vagus Nerve Stimulation: How Does It Work?

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The vagus nerve is one of the longest nerves in the body and plays a crucial role in the functioning of many vital organs. A problem with this nerve could indicate several health issues. Hence, vagus nerve stimulation is essential in restoring health and well-being. It involves implanting a device near the collarbone and firing electrical impulses to the nerve to send signals to the brain. It has shown efficacy in treating depression, epilepsy, and cardiovascular disease.

The vagus nerve is the tenth cranial nerve responsible for sensory and motor functions. It extends from the brainstem to various organs in the body, including the heart, lungs, and digestive system. Thus, electrical stimulation can help restore balance and functioning in these areas. In this guide, we will explore the mechanisms behind the stimulation of the vagal nerve and explore its applications in treating many conditions. In addition, we will delve into its safety and other guidelines.

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What Is Vagus Nerve Stimulation?

Vagus nerve stimulation is a medical procedure involving the implantation of a device called a VNS or pulse generator. It is typically placed under the skin in the upper chest area with a lead wire connecting to the vagus nerve. This device sends mild electrical impulses that send signals to the brain.

The exact mechanism of how electrical pulses help the vagus nerve is not fully understood. However, it is thought to involve the modulation of neurotransmitters. When the device delivers the pulses, it sends electrical signals to the brain. These impulses then travel along the nerve fibres to reach different areas of the brain, where they can modulate neural activity. This modulation can have various effects on the body, depending on the specific condition being treated.

The settings of the pulse generator can be adjusted by a health professional to optimise the effectiveness of the stimulation. Patients also receive a handheld magnet that can be placed over the device to deliver additional electrical pulses when needed. Overall, it increases the brain activity to synchronise and regulate some bodily functions that are not working properly.

Use Cases

  • Epilepsy: treat patients with epilepsy who do not respond well to medication.
  • Depression: improve mood in individuals with chronic or recurrent treatment-resistant depression.
  • Chronic migraines: adjunctive therapy for people with migraines, helping to reduce the frequency and severity of attacks.
  • Psychiatric disorders: it has shown promise in the treatment of Obsessive-compulsive Disorder (OCD) and Post-traumatic Stress Disorder (PTSD).
  • Stroke recovery: help people regain hand and arm functions after an ischemic stroke.
  • Obesity: targeted therapy may lead to improvement in obesity-related conditions like diabetes and high blood pressure.
  • Inflammatory bowel diseases (IBD): regulate inflammatory responses to rheumatoid arthritis and Crohn’s disease.

A woman holding holding her right shoulder

An Overview of Vagus Nerve Stimulation as a Therapeutic Approach

Vagus nerve stimulation is an FDA-approved therapeutic approach for various medical conditions. Firstly, the vagal nerve plays a key role in regulating many bodily functions, including heart rate, digestion, breathing, and cardiovascular activities. Thus, this treatment modality aims to restore balance, improve the normal functioning of vital organs, and alleviate the related conditions.

Secondly, it provides a drug-free approach to treating conditions that may not respond well to medication alone. Health professionals may also combine them with rehabilitation and other therapies to maximise their effectiveness. Moreover, it can help alleviate pain symptoms of several health conditions. Patients can control the stimulation and adjust the settings to meet individual needs.

Lastly, it helps in mood regulation. The electrical stimulation helps release neurotransmitters like serotonin, norepinephrine, and endorphins. Particularly, endorphins bind to opioid receptors to inhibit pain messages. They are the natural painkillers of the body. Therefore, these hormones play a role in reducing stress, anxiety, and pain perception. While it may not be a cure-all, it offers potential relief for those who have not responded well to traditional treatments.

Its Importance in Regulating Bodily Functions

The vagus nerve extends to the heart, lungs, cardiovascular system, and digestive system. It is responsible for communication between the brain and many vital organs. Hence, it regulates internal organ functions, such as breathing, digestion, and heart rate. It also controls the muscles of the throat and voice box.

The nerve is also responsible for certain reflex actions like coughing and sneezing and stimulation of muscle contractions in the parasympathetic nervous system. Another key importance is maintaining proper gut health. It ensures digestion and absorption of nutrients in the digestive system. This promotes a balanced gut-brain connection.

The back of a woman holding her shoulder

How Vagus Nerve Stimulation Works

Vagus nerve stimulation works using external stimuli to boost the normal activity of the cranial nerve and brain. One of the stimuli that can help is electrotherapy. This can be done by delivering small electrical pulses through a device. This allows for on-demand control of the stimulation. The nerves transmit the signals from the chest to the brain.

When the device is activated, it helps in balancing the autonomic nervous system, which controls many involuntary body functions. It involves “waking up” the nerve, restoring heart rate, digestion, and breathing. Additionally, it can activate specific neural pathways, which can be beneficial for individuals with high or low blood pressure and other medical conditions.

The device sends signals at intervals of a few minutes. The ideal length of the stimulation is 10 to 30 minutes per session to achieve a significant effect. Furthermore, it modulates the activity of various brain regions, including mood regulation and epilepsy control. The person may activate the device when sensing an aura to suppress or interrupt a seizure.

Understanding the Electrical Impulses

The nervous system relies on electrical impulses to transmit signals throughout the body. They are generated by specialised cells called neurons. The vagus nerve, specifically, carries these electrical signals from the brain to various organs and tissues in the body. The pulses from a device mimic the natural electrical activity of the nerve.

One notable effect of electrical impulses is the reduction of inflammation. The nerve communicates with various organs, including the spleen, which is responsible for immune response. In particular, stimulating the vagus nerve activates the release of acetylcholine. It is a neurotransmitter that produces anti-inflammatory effects.

A woman pinching her nose

Vagus Nerve Stimulation Applications: Treatment-Resistant Depression

Major depressive disorder (MDD) is a serious medical condition that negatively affects a person’s thoughts and mood. It can lead to various emotional problems that can affect the quality of life. A variety of treatment options are available, such as medications and therapy. However, some individuals may not respond well to them.

Vagus nerve stimulation is one of the promising options for individuals with treatment-resistant depression. Several practices have shown that the direct stimulation of the vagus nerve leads to significant improvements in depressive symptoms in individuals. This involves releasing certain neurotransmitters that play a role in regulating mood. With this, it helps alleviate symptoms of depression.

Aside from improving mood, nerve stimulation also helps increase the remission rate in patients. A study has shown sustained improvements in depressive symptoms for up to five years. This highlights the potential of electrical therapy as a long-term, non-pharmacological option. It can serve as an adjunctive treatment to other treatment methods in the battle against depression.

Benefits of the Treatment for Depression

  • Significantly reduce symptoms of depression in individuals who do not respond to traditional antidepressant medications.
  • Improve mood and overall well-being. The stimulation activates certain brain regions, resulting in positive changes.
  • Enhance neuroplasticity, the ability of the brain to reorganise and form new neural connections. This neural rewiring can reduce depressive symptoms and improve mental health in the long term.
  • Reduce potential suicidality for individuals with severe depression.
  • It has few and generally well-tolerated side effects by the patients. It is a non-invasive option and a safer alternative to some antidepressants, which can have adverse side effects.
  • Improve sleep quality and sleep patterns.

A man clutching his pained head with both hands

Vagus Nerve Stimulation Applications: Bipolar Disorder Management

Bipolar disorder is a chronic mental illness characterised by extreme mood swings and shifts in energy levels. It ranges from periods of intense mania to episodes of debilitating depression. Traditional treatment approaches include mood-stabilising medications and psychotherapy. However, some individuals may experience persistent symptoms or have difficulty tolerating medication side effects.

The vagus nerve stimulation provides an alternative for treating bipolar disorder. Similar to its use in major depression, it helps regulate mood by releasing neurotransmitters. It has shown a significant reduction in the frequency and severity of mood episodes, including both manic and depressive episodes. Additionally, it can give years of stable remission.

However, there are certain limitations to take into account. The treatment may not be suitable for everyone, as individual responses can vary. Stopping the stimulation can result in a serious relapse within a couple of months. Lastly, re-establishing remission may be difficult after a break. Therefore, it is crucial to follow a long-term plan to prevent potential adverse events.

Benefits of the Treatment for Bipolar Disorder

The benefits of the treatment include mood stabilisation. The electrical impulses help regulate the dysfunctional activity in the brain that contributes to mood swings. As a result, it lessens the frequency and severity of manic and depressive episodes of bipolar disorder. Consistent therapy can also give long-term remission.

Furthermore, it has the ability to enhance the efficacy of other treatments. Many individuals may combine medication, psychotherapy, and lifestyle medications with electrical stimulation. Thus, it can be a valuable complementary technique to improve symptoms and response rates. This means that individuals who previously had a limited response to conventional treatment may experience greater symptom relief.

A man who removed his glasses holding his neck

Vagus Nerve Stimulation Applications: Refractory Epilepsy Treatment

Epilepsy is a neurological disorder that causes recurrent seizures or uncontrollable shaking. It is a change in behaviour due to the sudden alteration of electrical patterns of the brain. While medications can help many individuals, some may have refractory epilepsy. This refers to cases where seizures do not respond to traditional antiepileptic drugs.

Vagus nerve stimulation offers a form of long-term treatment for people with refractory epilepsy. This helps reduce seizure activity by sending electrical impulses to the brain through the vagus nerve. It works by modulating the excitability of brain cells, preventing them from firing abnormally and triggering a seizure. Moreover, it is a treatment option for patients who are not candidates for surgery.

Individuals may control the stimulation of the device when they sense an oncoming seizure. A health professional can determine the appropriate settings and adjust the timing, intensity, and frequency of the impulses to achieve the best seizure control possible. Furthermore, regular follow-up appointments will be necessary to fine-tune the settings and monitor the effectiveness of the treatment.

Benefits of the Treatment for Epilepsy

The pulse generator delivers regular pulses to the brain, which helps regulate and stabilise abnormal brain activity. This helps reduce the occurrences of seizures, particularly shortening the length of the episode. Likewise, it is helpful for individuals who have a limited response to antiepileptic medications.

Another benefit is its long-term effectiveness. Patients experience a gradual reduction in the intensity of seizures as they continue treatment. In addition, the positive effects can be sustained over time. This can indicate a sustainable and reliable means of managing epilepsy for an extended period. This minimises the risk of unwanted side effects.

A woman sitting while clutching her shoulder and back

Vagus Nerve Stimulation Applications: Cardiovascular Disease Management

The vagus nerve plays a key role in regulating heart rate, blood pressure, and other important cardiovascular functions. By stimulating this nerve, it helps modulate the activity of the nervous system, which controls these functions. This helps treat several cardiovascular diseases, including heart failure, arrhythmias, and hypertension.

One of the conditions that can benefit from vagus nerve stimulation is heart failure. It is a chronic condition in which the heart is unable to pump enough blood efficiently. This treatment improves cardiac function and reduces symptoms of heart failure, such as shortness of breath and fatigue. This can lead to better regulation of heart rate and blood pressure to their normal levels.

Another potential application is the treatment of hypertension or high blood pressure. Hypertension is a major risk factor for the development and progression of cardiovascular diseases. The electronic pulses help decrease blood pressure within a healthy range by modulating sympathetic and parasympathetic activity. Overall, it shows positive effects in improving cardiovascular health.

Benefits of the Treatment for Stroke Recovery

  • Improve motor function and functional mobility after a stroke.
  • Enhance cognitive function and memory, helping with neurological impairments that often occur after a stroke.
  • Reduce inflammation and promote healing of brain tissue, aiding in accelerated recovery of stroke.
  • Improve mood and reduce symptoms of depression and anxiety that are common with stroke.
  • The vagal nerve stimulation with rehabilitative exercise generates more limb functions than with physical therapy alone.
  • Reduce muscle stiffness and spasms. It enables smoother movements and a greater range of motion.
  • Restore swallowing function and improve speech impairments.
  • Increase blood flow and oxygenation in the brain.

A woman with her hand on her shoulder

Right Cervical Vagus Nerve Stimulation

The vagus nerve is divided into two branches, the left and right vagus nerves. While both branches play a role in regulating various bodily functions, recent studies have shown that right cervical vagus nerve stimulation (r-VNS) may have specific benefits for certain conditions. This technique involves the placement of electrodes on the right side of the neck.

r-VNS sends signals to various areas of the brain that are responsible for regulating pain, mood, and other neurological functions. By targeting the right side of the neck, it can specifically activate the cervical branch of the vagus nerve and provide localised benefits. It is also effective in managing heart failure in preclinical studies. Additionally, it has positive outcomes in chronic inflammatory diseases.

One potential application of r-VNS is in the management of migraine headaches. Migraines are severe head pain, sensitivity to light and sound, and nausea. By stimulating the vagus nerve, r-VNS can help alleviate these symptoms and reduce the frequency and intensity of migraine attacks.

How It Works

r-VNS sends regular doses of electric pulses to the vagus nerve in the neck. These impulses travel along the nerve pathway and stimulate various areas of the brain and body, influencing the autonomic nervous system. Particularly, it stimulates the limbic system and frontal cortex, which are responsible for controlling emotions.

The implantable device connects to the right cervical vagus nerve and activates vagal efferent fibres. This stimulation produces more significant effects on mood and cognition than the left vagus nerve. In addition, epileptic patients may pursue this if they find it has better effects than with left vagal nerve stimulation.

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Transcutaneous Forms of Vagus Nerve Stimulation

Transcutaneous Vagus Nerve Stimulation (tVNS) is another form of treatment using a non-invasive approach. Instead of an implanted device, tVNS involves the use of external electrical applications. This method is administered transcutaneously, meaning through the skin. Hence, it offers a more accessible and convenient option for individuals seeking effective treatment without undergoing surgery.

tVNS uses an electric pulse machine to send low-voltage electrical currents to the nerves. The procedure includes attaching adhesive electrode pads to the ear or neck. A health professional can guide patients through the proper placement and usage of the electrodes to avoid unnecessary risks. Aside from the treatment of epilepsy and depression, this method helps in managing chronic pain.

One advantage of tVNS is its portability and ease of use. Individuals can use a small handheld device and place it on the affected area. For pain management, the electrodes go on either side of the painful area or painful joints. It is beneficial for various conditions, such as arthritis, sciatica, bursitis, fibromyalgia, and period or abdominal pain.

How It Works

Transcutaneous nerve stimulation works by overriding the nervous system with electrical currents. The currents pass through the skin, reaching the underlying nerves. In low frequencies (2-10 Hz), it triggers the release of endorphins. It also stimulates the motor nerves, improving blood circulation in the area.

In high frequencies (50-120 Hz), the currents stimulate the sensory nerves to block pain signals. This mechanism is known as pain gating, where certain nerve fibres close the pathways of pain signals to the brain. Consequently, it lessens pain levels. The settings of the device are adjustable to suit individual comfort levels.

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Safety Guidelines for Vagus Nerve Stimulation

Observing safety guidelines for vagus nerve stimulation is crucial to ensure the well-being of individuals. First and foremost, it is essential to conduct a thorough evaluation of the medical history and overall health of a patient considering this treatment option. This assessment helps identify potential contraindications or risk factors that may make the process unsafe for the individual.

Secondly, patients must follow the operation guidelines as instructed by their healthcare provider. This involves how and when to adjust the intensity or frequency levels. It is also important to follow a regular check-up to make necessary adjustments to parameters. In any case of discomfort, pain, or adverse reactions, patients should immediately contact their provider.

For transcutaneous devices, individuals should always start with the lowest settings and gradually increase. It is also crucial to ensure proper electrode placement. Do not place the electrode pads on the chest and back at the same time, on the head, or directly over the spine. Also, do not use the device in water or while driving or sleeping.

Who Is Suitable for the Treatment?

  • Vagal nerve stimulation is an FDA-approved treatment for children with epilepsy aged four years and older.
  • Adults with treatment-resistant depression or refractory epilepsy who do not respond well to medication.
  • Individuals who suffer from acute and chronic pain conditions can benefit from transcutaneous nerve stimulation.
  • People seeking non-invasive and drug-free alternatives for anxiety, depression, and PTSD.
  • Individuals recovering from sports injuries, postoperative pain, and stroke.
  • People with IBD and other neurological conditions.


  • Individuals with one vagus nerve.
  • Patients who are receiving other forms of brain stimulation.
  • People with other serious medical conditions should consult a doctor first.


Vagus nerve stimulation therapy is a medical approach that can help regulate bodily functions and treat various conditions such as depression, bipolar disorder, epilepsy, and cardiovascular disease. It works by implanting a device near the collarbone to send electrical impulses to the vagus nerve and stimulate it. The treatment has shown numerous benefits in improving symptoms and overall well-being. This is especially beneficial for people who are not responding well to drugs.

Those who are not suitable candidates for surgery may opt for tVNS or transcutaneous nerve stimulation. It involves the use of a portable machine that sends mild electrical pulses through electrodes placed on the skin. These devices allow individuals to control the stimulation by controlling the frequency and intensity levels. However, it is important to follow safety guidelines to ensure its effectiveness and minimise risks. Lastly, regular consultation with a health professional is vital throughout the treatment.

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