A clinical study on the augmented therapeutic effects of transcutaneous auricular vagus nerve stimulation combined with repetitive transcranial magnetic stimulation in the treatment of moderate-to-severe depression

Abstract

Objective: To evaluate the clinical efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of moderate-to-severe depression.

Methodology: This was a retrospective study. A total of 180 patients diagnosed with moderate-to-severe depression and admitted to Hebei Provincial Mental Health Center between July 2023 to March 2025 were enrolled and randomized into three groups(n= 60 each) using a random number table: the taVNS group (Group-A), the rTMS group (Group-R) and the taVNS + rTMS group (Group-C). All patients underwent a 4-week treatment course. Clinical outcomes, changes in depression severity, sleep quality and incidence of adverse events were assessed post-treatment. All outcome assessments were conducted under blinded conditions using standardized rating scales.

Results: The overall response rate was 85% in Group-C, significantly higher than the 70% in Group-A and the 66% in Group-R (p= 0.02). Additionally, patients in Group-C showed significantly greater reductions in both Clinical Global Impression and Pittsburgh Sleep Quality Index scores compared with Groups A and R (both p= 0.00). No statistically significant differences were observed among the three groups in the incidence of adverse events(p= 0.60).

Conclusion: The combination of taVNS and rTMS demonstrates a synergistic effect in the treatment of moderate-to-severe depression, which is considered a safe and effective therapeutic strategy as it can significantly improve clinical symptoms and sleep quality without increasing adverse effects.