Skip to main content

Advertisement

SpringerLink
Log in

Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

Invasive vagus nerve stimulation has been demonstrated to be an effective treatment in major depressive episodes. Recently, a novel non-invasive method of stimulating the vagus nerve on the outer canal of the ear has been proposed. In healthy subjects, a prominent fMRI BOLD signal deactivation in the limbic system was found. The present pilot study investigates the effects of this novel technique of auricular transcutaneous electric nerve stimulation in depressed patients for the first time. A total of 37 patients suffering from major depression were included in two randomized sham controlled add-on studies. Patients were stimulated five times a week on a daily basis for the duration of 2 weeks. On days 0 and 14, the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) were assessed. In contrast to sham-treated patients, electrically stimulated persons showed a significantly better outcome in the BDI. Mean decrease in the active treatment group was 12.6 (SD 6.0) points compared to 4.4 (SD 9.9) points in the sham group. HAMD score did not change significantly in the two groups. An antidepressant effect of a new transcutaneous auricular nerve stimulation technique has been shown for the first time in this controlled pilot study. Regarding the limitations of psychometric testing, the risk of unblinding for technical reasons, and the small sample size, further studies are necessary to confirm the present results and verify the practicability of tVNS in clinical fields.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn., text revision. APA Press, Washington, DC

    Google Scholar 

  • Avery D, Winokur G (1977) The efficacy of electroconvulsive therapy and antidepressants in depression. Biol Psychiatry 12(4):507–523

    PubMed  CAS  Google Scholar 

  • Bajbouj M, Merkl A, Schlaepfer TE, Frick C, Zobel A, Maier W et al (2010) Two-year outcome of vagus nerve stimulation in treatment-resistant depression. J Clin Psychopharmacol 30(3):273–281

    Article  PubMed  Google Scholar 

  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  PubMed  CAS  Google Scholar 

  • Berthoud HR, Neuhuber WL (2000) Functional and chemical anatomy of the afferent vagal system. Auton Neurosci. 85(1–3):1–17

    Article  PubMed  CAS  Google Scholar 

  • Bewernick BH, Hurlemann R, Matusch A, Kayser S, Grubert C, Hadrysiewicz B et al (2010) Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol Psychiatry 67(2):110–116

    Article  PubMed  Google Scholar 

  • Bystritsky A, Kerwin L, Feusner J (2008) A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. J Clin Psychiatry 69(3):412–417

    Article  PubMed  Google Scholar 

  • Daban C, Martinez-Aran A, Cruz N, Vieta E (2008) Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression. A systematic review. J Affect Disord 110(1–2):1–15

    Article  PubMed  Google Scholar 

  • Daskalakis ZJ, Levinson AJ, Fitzgerald PB (2008) Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Can J Psychiatry 53(9):555–566

    PubMed  Google Scholar 

  • Dietrich S, Smith J, Scherzinger C, Hofmann-Preiss K, Freitag T, Eisenkolb A et al (2008) A novel transcutaneous vagus nerve stimulation leads to brainstem and cerebral activations measured by functional MRI. Biomed Tech (Berl) 53(3):104–111

    Article  Google Scholar 

  • Fallgatter AJ, Neuhauser B, Herrmann MJ, Ehlis AC, Wagener A, Scheuerpflug P et al (2003) Far field potentials from the brain stem after transcutaneous vagus nerve stimulation. J Neural Transm. 110(12):1437–1443

    Article  PubMed  CAS  Google Scholar 

  • Fallgatter AJ, Ehlis AC, Ringel TM, Herrmann MJ (2005) Age effect on far field potentials from the brain stem after transcutaneous vagus nerve stimulation. Int J Psychophysiol 56(1):37–43

    Article  PubMed  Google Scholar 

  • Fitzgerald PB, Benitez J, de Castella A, Daskalakis ZJ, Brown TL, Kulkarni J (2006) A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression. Am J Psychiatry 163(1):88–94

    Article  PubMed  Google Scholar 

  • Frank E, Eichhammer P, Burger J, Zowe M, Landgrebe M, Hajak G et al (2010) Transcranial magnetic stimulation for the treatment of depression: feasibility and results under naturalistic conditions: a retrospective analysis. Eur Arch Psychiatry Clin Neurosci 261(4):261–266

    Google Scholar 

  • Greif R, Laciny S, Mokhtarani M, Doufas AG, Bakhshandeh M, Dorfer L et al (2002) Transcutaneous electrical stimulation of an auricular acupuncture point decreases anesthetic requirement. Anesthesiology 96(2):306–312

    Article  PubMed  Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  PubMed  CAS  Google Scholar 

  • Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA et al (2010) Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety 27(4):351–364

    Article  PubMed  Google Scholar 

  • Kraus T, Hösl K, Kiess O, Schanze A, Kornhuber J, Forster C (2007) BOLD fMRI deactivation of limbic and temporal brain structures and mood enhancing effect by transcutaneous vagus nerve stimulation. J Neural Transm. 114(11):1485–1493

    Article  PubMed  CAS  Google Scholar 

  • Lampl C, Kreczi T, Klingler D (1998) Transcutaneous electrical nerve stimulation in the treatment of chronic pain: predictive factors and evaluation of the method. Clin J Pain 14(2):134–142

    Article  PubMed  CAS  Google Scholar 

  • Loo CK, Sachdev P, Martin D, Pigot M, Alonzo A, Malhi GS et al (2010) A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Int J Neuropsychopharmacol 13(1):61–69

    Article  PubMed  Google Scholar 

  • Luijpen MW, Swaab DF, Sergeant JA, Scherder EJ (2004) Effects of transcutaneous electrical nerve stimulation (TENS) on self-efficacy and mood in elderly with mild cognitive impairment. Neurorehabil Neural Repair. 18(3):166–175

    Article  PubMed  Google Scholar 

  • Marangell LB, Martinez M, Jurdi RA, Zboyan H (2007) Neurostimulation therapies in depression: a review of new modalities. Acta Psychiatr Scand 116(3):174–181

    Article  PubMed  CAS  Google Scholar 

  • Polak T, Ehlis AC, Langer JB, Plichta MM, Metzger F, Ringel TM et al (2007) Non-invasive measurement of vagus activity in the brainstem: a methodological progress towards earlier diagnosis of dementias? J Neural Transm. 114(5):613–619

    Article  PubMed  CAS  Google Scholar 

  • Polak T, Markulin F, Ehlis AC, Langer JB, Ringel TM, Fallgatter AJ (2009a) Far field potentials from brain stem after transcutaneous vagus nerve stimulation: optimization of stimulation and recording parameters. J Neural Transm. 116(10):1237–1242

    Article  PubMed  Google Scholar 

  • Polak T, Markulin F, Ehlis AC, Metzger F, Langer JB, Ringel TM et al (2009b) Auricular vagus somatosensory evoked potentials in vascular dementia. J Neural Transm. 116(4):473–477

    Article  PubMed  CAS  Google Scholar 

  • Sackeim HA, Rush AJ, George MS, Marangell LB, Husain MM, Nahas Z et al (2001) Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology 25(5):713–728

    Article  PubMed  CAS  Google Scholar 

  • Scherder EJ, Van Someren EJ, Bouma A, vd Berg M (2000) Effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behaviour in aging. Behav Brain Res 111(1–2):223–225

    Article  PubMed  CAS  Google Scholar 

  • Schlaepfer TE, Frick C, Zobel A, Maier W, Heuser I, Bajbouj M et al (2008) Vagus nerve stimulation for depression: efficacy and safety in a European study. Psychol Med 38(5):651–661

    Article  PubMed  CAS  Google Scholar 

  • Shelton RC, Osuntokun O, Heinloth AN, Corya SA (2010) Therapeutic options for treatment-resistant depression. CNS Drugs. 24(2):131–161

    Article  PubMed  CAS  Google Scholar 

  • Shern DL, Moran H (2009) STAR*D: helping to close the gap between science and practice. Psychiatr Serv 60(11):1458–1459

    Article  PubMed  Google Scholar 

  • Stegmann ME, Ormel J, de Graaf R, Haro JM, de Girolamo G, Demyttenaere K et al (2010) Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 124(1–2):38–44

    Article  PubMed  Google Scholar 

  • Ventureyra EC (2000) Transcutaneous vagus nerve stimulation for partial onset seizure therapy. A new concept. Childs Nerv Syst. 16(2):101–102

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  • Zobel A, Joe A, Freymann N, Clusmann H, Schramm J, Reinhardt M et al (2005) Changes in regional cerebral blood flow by therapeutic vagus nerve stimulation in depression: an exploratory approach. Psychiatry Res 139(3):165–179

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Frankenalb-Klinik Engelthal, Clinic for Psychiatry, Psychotherapy, Psychosomatic Medicine, and Addiction Rehabilitation, Reschenbergstraße 20, 91238, Engelthal, Germany

    Ernst Hein, Magdalena Nowak & Thomas Kraus

  2. Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany

    Olga Kiess, Teresa Biermann, Kristina Bayerlein & Johannes Kornhuber

Authors
  1. Ernst Hein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Magdalena Nowak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olga Kiess
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa Biermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristina Bayerlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Kornhuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ernst Hein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hein, E., Nowak, M., Kiess, O. et al. Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study. J Neural Transm 120, 821–827 (2013). https://doi.org/10.1007/s00702-012-0908-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-012-0908-6

Keywords

Search

Navigation