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Vagus Nerve Stimulation for Depression in Rochester, NY
When depression has outlasted medication after medication, and even other advanced treatments haven't worked, there is still other options. We discuss Vagus nerve stimulation (VNS) with many of our patient that have not responded to many other treatments.
VNS is an FDA-approved implanted neuromodulation therapy for chronic or recurrent depression that has not responded adequately to four or more antidepressant treatments. A small pulse generator placed under the skin of the upper left chest delivers programmed electrical stimulation to the left vagus nerve in the neck, and that signal reaches brain regions involved in mood regulation. VNS is a long-term treatment: its effects build over months, not weeks.
VNS is not a first-line option and it is not right for every patient. At Nexus, our interventional psychiatrists determine whether it fits your treatment history, coordinate the implant with a surgical partner, and manage follow-up afterward.
How Vagus Nerve Stimulation Works for Depression
The vagus nerve is the principal nerve of the parasympathetic nervous system, and most of its fibers carry information from the body to the brain. Stimulating the left cervical vagus nerve sends signals to the nucleus of the solitary tract in the brainstem, which projects to the locus coeruleus, the raphe nuclei, and limbic and prefrontal networks involved in mood regulation. With sustained stimulation, activity and neurotransmitter signaling in these circuits appear to change. The precise mechanism of the antidepressant effect is not fully established.
The device runs on a programmed schedule of pulses, day and night. There are no sessions to attend and no doses to take. Nothing is placed in or on the brain: the generator sits under the skin of the chest, and the lead wraps around the vagus nerve in the neck.
Who Is a Candidate for VNS
The FDA indication covers adults 18 and older in a major depressive episode with chronic or recurrent depression, unipolar or bipolar, that has not responded adequately to four or more antidepressant treatments. In practice, candidacy is a more detailed question than the label. We review every medication, dose, and duration you have tried, whether each trial was adequate, and what augmentation, psychotherapy, TMS, ketamine, Spravato, or ECT you have received.
We also weigh diagnostic accuracy, medical comorbidity, surgical risk, and whether you can commit to the follow-up VNS requires. It is most often considered for patients who need long-term stability, who respond to acute treatments and then relapse, or who do not tolerate medications well. If an earlier option such as
TMS therapy
or
Spravato
has not been tried, one of those may be the better place to start, and we will say so.
What the Evidence Shows
The evidence for VNS differs from the evidence for acute treatments such as TMS or ECT. The pivotal sham-controlled trial did not show a significant difference between active and sham stimulation over its 10-week acute phase. The case for VNS rests on longer-term data, in which response and remission rates appear to rise over the first year or more of stimulation, and on comparisons with treatment as usual that favored VNS. Those comparisons were not randomized, and individual outcomes vary. A recent expert consensus notes that maximum benefit can take 18 months or longer, which is why we frame VNS as a long-term commitment and do not promise a particular result.
What to Expect, From First Visit to Long-Term Follow-Up
- Interventional psychiatry consultation: In an interventional psychiatry consultation, we review your psychiatric and medical history and every treatment you have tried, then discuss all of your options, not only VNS.
- Candidacy and coverage review: If VNS fits, we confirm the clinical criteria and determine what your insurance requires before any procedure is scheduled.
- Implant procedure with a surgical partner: A surgeon places the generator under the skin of the upper left chest and connects a thin lead to the left vagus nerve in the neck. This is an outpatient procedure.
- Activation and titration: Stimulation is typically turned on about two weeks after surgery. It starts at a low output and is increased in small steps, with more frequent visits in the first months (O’Reardon et al., Psychiatry, 2006). We perform these adjustments in our office based on your responses.
- Long-term follow-up: We track symptoms over time with tools such as the
PHQ-9 depression assessment and adjust settings as needed. You keep your current psychiatrist and therapist, and we coordinate with them. Medication changes can be made but done so cautiously, since a 2026 expert consensus recommends avoiding medication reductions for at least the first year after implantation (UTHealth Houston summary, 2026).
Cost and Coverage
The cost of VNS has three components: the device and procedure, billed by the implanting surgeon and facility; programming and follow-up visits over the first year and beyond; and your insurance plan’s rules, including prior authorization.
Medicare has covered VNS for treatment-resistant depression only within CMS-approved clinical studies since its
2019 national coverage decision, and the manufacturer requested a reconsideration in 2025. Commercial plans vary. Our staff reviews your insurance before scheduling and explains your costs before anything moves forward.
Why Nexus for VNS Evaluation
Nexus is a physician-owned practice focused on interventional psychiatry. Our founders built it to bring newer treatments to the greater Rochester area in a more comfortable setting than larger institutions. Dr. Shane Stegen, MA, DO, and Dr. Nadine Mills, MD have completed specialized training from the original developer of VNS and work close with the medical device team and researchers to offer the most advanced treatments available.
We offer TMS, accelerated TMS, Spravato, IV ketamine, and VNS, and our psychiatrists also deliver ECT within the area hospital system. That range matters for VNS because the right recommendation depends on what you have already tried, and it should not be driven by any single device.
Questions About Vagus Nerve Stimulation for Depression
Who is a good candidate for VNS for depression?
Adults 18 and older in a major depressive episode with chronic or recurrent depression, unipolar or bipolar, who have not responded adequately to four or more antidepressant treatments. It is often considered when a patient needs long-term stability, tolerates medications poorly, or has relapsed after other treatments. A consultation is the way to determine fit.
How long does VNS take to work?
Months. Benefit builds gradually, and many patients who respond first notice change in the second six months of stimulation. A recent expert consensus notes that maximum benefit can take 18 months or longer. VNS is planned as a long-term treatment for that reason.
What are the side effects of VNS?
The most common is hoarseness or a change in voice while the device is stimulating. Cough, throat or neck discomfort, and shortness of breath can also occur. These often ease over time or with setting adjustments, and stimulation can be paused with a handheld magnet. Surgery carries its own risks, including pain or infection at the incision.
Is VNS brain surgery?
No. The generator sits under the skin of the chest and the lead connects to the vagus nerve in the neck. Nothing is placed in or on the brain. The vagus nerve carries the signal to brain regions involved in mood.
Can I keep my medications and other treatments with VNS?
Yes. VNS is approved as an adjunctive treatment, and most patients continue medications and therapy after implantation. Some also continue treatments such as Spravato or ketamine as part of a broader plan. We coordinate changes with your existing providers and make them slowly, particularly during the first year.
Book a VNS Consultation
If your depression has persisted through many treatments, our care for treatment-refractory depression brings every option into a single plan, and VNS is one of them.
Call (585) 201-8508
or
request a VNS consultation. We see patients Monday through Friday, 10am to 7pm, by appointment only.
