Clearing the Traffic for Treating Major Depression
We have all heard of depression, and many of us have struggled with feeling down during difficult times in our lives: the death of a loved one, major life changes, or stressful events. For most people, these feelings are like traffic jams, frustrating and slow, but will improve with time. For others, the traffic jam never clears, leading to major depression.
What is MDD?
Around 21% of adults in the U.S. will develop major depressive disorder (MDD) at some point in their lives.[1] To be diagnosed with MDD, a person must have:[2]
- At least one (1) of the following symptoms:
- Depressed mood: feeling sad, empty, or hopeless
- Anhedonia: loss of interest or pleasure in activities that once brought you happiness
- And at least four (4) of the following symptoms:
- Noticeable changes in weight or appetite
- Trouble sleeping or sleeping too much
- Feeling restless or unusually slowed down
- Fatigue or low energy
- Feelings of worthlessness or excessive guilt
- Difficulty thinking clearly, concentrating, or making decisions
- Repeated thoughts about death or suicide
These symptoms must be present for most of the day, nearly every day, and last for at least two weeks.
These are the very basic criteria for major depressive disorder, though it is more than just feeling “down.” Major depression can affect nearly every part of life. Many people find it difficult to work, socialize, or do basic self-care tasks.
MDD Treatments
On a recent MedEvidence podcast,[3] Dr. Heather Luing emphasized a holistic approach to treating depression. She starts by looking at lifestyle factors:
- Are you getting enough sleep?
- Are you eating a diet that supports brain health?
- Are you moving your body enough?
For many, even small lifestyle changes can make a meaningful difference in mood. Evidence shows that exercise has antidepressant effects; walking or jogging, yoga, and strength training are the most effective.[4]
Lifestyle changes are important, but many people need additional support. Therapy and medication are the next steps. For some people, talk therapy will be enough, while others will need a biological approach as well. Traditionally, the first medications prescribed are antidepressants.A combination of these strategies works for many, but for some people, depression does not improve with lifestyle changes, therapy, or medication. This is called treatment-resistant depression (TRD). For people with TRD, there are additional and lesser-known neuromodulation treatment options, one of which is Vagus Nerve Stimulation (VNS) therapy.
What Is The Vagus Nerve?
If you have ever traveled anywhere in the United States, you will have driven on the interstate highway system. Heavy traffic or accidents on the highway affect many people. The vagus nerve is the longest communication highway in the body, and connects the brain to the heart, lungs, and digestive system. When signals along this route are disrupted, it can affect many parts of the body, including mood and emotions.
What Is Vagus Nerve Stimulation?
Vagus nerve stimulation (VNS) is FDA-approved as an add-on therapy for treatment-resistant depression. It has been approved for depression in the United States since July 2005.[5] VNS is a non-drug treatment that uses a small medical device.[6] The device is placed under the skin in the chest during a short outpatient procedure with a thin wire connected to the vagus nerve in the neck. Vagus nerve stimulation helps traffic move by stimulating the nerve, supporting brain areas involved in mood and emotion.
VNS is not new, but access has been limited for many patients in the U.S. because insurers, especially Medicare, do not routinely cover it. To help change this, depression experts designed the RECOVER study,[6], a Medicare-approved clinical trial created to gather the evidence needed to expand coverage. If results align with prior research, vagus nerve stimulation could become more accessible to those who need it most. With continued research and expanded access, the traffic is finally starting to move, and for many patients, the road ahead looks brighter than ever.If you or someone you know is struggling with mental health, emotional distress, or substance concerns, you are not alone. Call or text 988 to connect with a caring counselor at the 988 Suicide & Crisis Lifeline.
Director of Creative Strategies Rebecca Simpson, CCRP
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References:
[1] Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry. 2018;75(4):336–346. doi:10.1001/jamapsychiatry.2017.4602
[2] Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for child serious emotional disturbance [Internet]. Substance Abuse and Mental Health Services Administration. 2016. Accessed December 22, 2025. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5
[3] Luing H, Schramm E. Modern psychiatry offers new hope for depression. MedEvidence!. 2025. Accessed December 22, 2025.
https://medevidence.com/modern-psychiatry-offers-new-hope-for-depression
[4] Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, del Pozo Cruz B, Van Den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, Pagano R. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024 Feb 14;384. https://pubmed.ncbi.nlm.nih.gov/38355154/
[5] US Food and Drug Administration. Premarket approval (PMA) for VNS Therapy system. US Department of Health & Human Services. Accessed December 22, 2025. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=p970003s050
[6] LivaNova US. SYMMETRY for difficult to treat depression. Accessed December 22, 2025. https://www.livanova.com/depression/en-us/what-is-symmetry
