Brain Stimulation (Neuromodulation)

The three most common types of neuromodulation are:

1. Electroconvulsive therapy (ECT)
2. Repetitive Transcranial Magnetic Stimulation (rTMS or TMS)
3. Vagus Nerve Stimulation (VNS)

Electroconvulsive Therapy (ECT)

ECT is a medical procedure performed under general anesthesia, meaning you’re completely asleep and won’t feel anything. During the procedure, brief electrical currents are passed through the brain using small electrodes on the scalp. These pulses trigger controlled seizures that cause chemical changes in the brain, which can quickly relieve symptoms of depression and other similar conditions.

Doctors believe that ECT alters the levels of neurotransmitters (brain chemicals) and stress hormones, which in turn influence energy, sleep, appetite, and mood.

What to expect

A trained team of medical professionals, including a psychiatrist and an anesthesiologist, administers ECT. You’ll receive anesthesia and a muscle relaxant beforehand. 

The entire session takes about 10–20 minutes. Most people receive ECT three times a week for 6-12 sessions, although some may need up to 18 sessions. Symptoms usually begin to improve after several sessions.

Side effects

Common short-term effects of ECT include:

• Headache
• Muscle aches
• Nausea
• Temporary confusion or memory problems

These effects typically fade within hours. Some people may notice memory gaps that last a bit longer, especially if treatment is delivered on both sides of the head.

Safety

ECT is considered safe, with a risk level comparable to other short procedures performed under anesthesia, such as colonoscopies or dental procedures. Serious complications are rare.

Repetitive Transcranial Magnetic Stimulation (TMS)

TMS is a noninvasive treatment that uses magnetic fields to stimulate brain cells linked to mood regulation. A magnetic coil is placed gently against your scalp to deliver repeated magnetic pulses.

What to expect

TMS doesn’t require anesthesia or surgery. It’s performed in a doctor’s office, and you can resume normal activities afterward. Treatments last about 30 minutes and are typically performed five days a week, for five to six weeks.

Side effects

Some people experience scalp discomfort or headaches during the first week of treatment. These symptoms typically ease over time.

Safety

TMS is very safe. Serious side effects, like seizures, are rare. People with seizure disorders, brain tumors, or metal implants should talk to their health care provider before starting TMS.

Vagus Nerve Stimulation (VNS)

VNS delivers mild electrical pulses to the brain through the vagus nerve, which helps regulate mood, sleep, appetite, and motivation. It’s a good option for adults with chronic or recurring depression or bipolar disorder that hasn’t responded to other treatments or ECT.

During VNS treatment, doctors place a small device under the skin of your upper chest, connected to the vagus nerve in your neck. The device gently sends electrical signals to the brain to help balance mood.

Approximately one in three people experiences a significant improvement with VNS after several months. Those who see benefits within a year are likely to maintain them for several years.

What to expect

VNS is a surgical implantation performed under general anesthesia, meaning you’re completely asleep and won’t feel anything. The procedure to implant the VNS device typically lasts one to two hours, and most people are discharged the same day. About a week or two after surgery, your doctor will activate the device and gradually adjust the settings over several weeks. Researchers are also developing new, non-surgical versions of the device that can be placed on the neck.

Side effects

During VNS, some people experience side effects, such as:

• Cough
• Headache or neck discomfort
• Temporary voice changes or hoarseness
• Throat tightness

These symptoms typically occur only during stimulation periods, not as a result of the surgery itself.

Safety

VNS is safe, but it is a surgical procedure, which makes it riskier than other depression treatments.
 

Researchers are studying advanced brain stimulation techniques, such as Deep Brain Stimulation (DBS) and Transcranial Direct Current Stimulation (tDCS), to find new ways to treat depression: 

• DBS involves surgically implanting electrodes in specific brain areas. Though it’s FDA-approved for Parkinson’s disease, DBS’s ability to treat depression is still being studied.
• tDCS uses a mild electrical current applied through the scalp for 10-30 minutes. Early studies show promise, but it’s not yet FDA-approved for depression.

If you’re interested in treatments like these, talk with your health care provider about ongoing clinical trials and safety considerations.