Interventional Psychiatry · Implantable Neuromodulation
VNS Therapy
Vagus nerve stimulation (VNS) is an FDA-approved, long-term treatment for chronic, treatment-resistant depression. A small pacemaker-like device sends gentle, regular pulses through the vagus nerve to brain regions involved in mood — working in the background, every day, alongside your other care.
Overview
What is VNS therapy?
The vagus nerve runs from the brainstem down through the neck and chest, carrying signals between the body and brain regions that help regulate mood, sleep, and stress. It's a key part of the body's "rest and digest" system.
VNS uses an implanted device to stimulate the left vagus nerve on a programmed schedule. Those signals travel up to mood-regulating areas of the brain. The FDA approved VNS in 2005 for adults with chronic or recurrent depression that hasn't responded to several prior treatments.
At a glance
- Designed for long-standing depression that other treatments haven't resolved
- Works continuously — no daily pill or clinic schedule to keep
- Used alongside medication, therapy, and other treatments
- Settings adjusted quickly in the office, without surgery
- Benefits typically build gradually over months
What to Expect
Your path to VNS
- Psychiatric evaluation. Your Mindspring psychiatrist reviews your history and prior treatments to confirm VNS is appropriate for you.
- Insurance and surgical referral. VNS is often covered by insurance for eligible patients, but approval can take months. We coordinate the referral and records; the device manufacturer typically helps with authorization.
- Outpatient implant. A surgeon places a small device under the skin below the left collarbone, with a thin wire to the vagus nerve in the neck. The procedure usually takes 1–2 hours, and most patients go home the same day.
- Programming. A few weeks later, your psychiatrist turns the device on and gradually increases the stimulation in short, painless office visits using a wireless wand.
- Long-term follow-up. We track your progress over months and fine-tune settings. The battery lasts years and is replaced with a minor procedure.
Candidacy
Who may be a candidate
- Adults with chronic or recurrent major depression or bipolar depression
- Depression that hasn't improved after several adequate treatments
- Patients who need a durable, long-term strategy rather than another short course
- Those who have tried options like TMS or ketamine without lasting relief
Safety
Side effects
The most common side effects are hoarseness, voice changes, cough, or a tickle in the throat — mostly only during the brief periods when the device is actively stimulating. These usually lessen over time and can often be improved by adjusting settings.
As with any surgery, there are small risks such as infection or pain at the incision site. Your surgeon will review these with you.
Evidence
What the research shows
VNS has been studied for depression for more than 20 years. In a large five-year registry of nearly 800 patients with treatment-resistant depression, those who received VNS added to their usual care had better long-term response and remission rates than those who continued usual care alone. Many patients who respond continue to improve over the first one to two years.
Mindspring Health is self-pay for our psychiatric visits and does not bill insurance — see the Fees page. The VNS device and implant surgery are billed separately by the surgical team and hospital, and are often covered by insurance for eligible patients.
Physician-Led Care
Overseen by a board-certified psychiatrist
Dr. A. Umair Janjua, M.D., FAPA, founded Mindspring Health and oversees its interventional psychiatry program. Every interventional treatment is reviewed with you by a psychiatrist before it becomes part of your plan, and monitored and adjusted the same way the rest of your care is.
Common Questions
Frequently Asked Questions
Is VNS FDA-approved for depression?
Yes. The FDA approved VNS in 2005 as an adjunctive long-term treatment for adults with chronic or recurrent depression that hasn't responded adequately to prior treatments.
Where is the device implanted?
Under the skin of the upper left chest, below the collarbone, with a thin wire running to the vagus nerve in the neck. The surgery is done by a surgeon at an outpatient hospital or surgery center.
Will people be able to see it?
The device is about the size of a silver dollar. In slimmer patients it may be visible as a small bump; the wire isn't visible.
How long until it works?
VNS works gradually. Some people notice changes within a few months, and improvement often continues over the first year or two.
Do I still need my medications?
Usually, yes. VNS is designed to be used alongside your existing treatment, and your psychiatrist may adjust medications over time.
Does it hurt when it's on?
Most people don't feel pain. You may notice a change in your voice or a tickle in your throat when it stimulates, which usually fades as you adjust.
Can I have an MRI with VNS?
Many MRI scans are possible with specific precautions. Always tell your care team you have a VNS device before any imaging.
Does insurance cover VNS?
Many insurers cover the device and implant for eligible patients, but prior authorization can take several months. Mindspring's psychiatric visits are self-pay; we can provide a superbill.
Interventional Psychiatry
Other options we offer
Single-Day Protocol
ONE-Day TMS
A full TMS course in one clinic day.
1–2 Week Protocol
Accelerated TMS
Multiple short sessions per day over 1–2 weeks.
Standard Daily Protocol
Standard rTMS
One session a day, the most-studied schedule.
In-Office Infusion
IV Ketamine Therapy
Medically supervised infusion series.
EEG-Guided Neurofeedback
PRISM for PTSD
Medication-free, FDA-cleared PTSD therapy.
Find out if you're a candidate
Every interventional treatment at Mindspring Health starts with a comprehensive psychiatric evaluation by a board-certified psychiatrist.