You have been battling depression for three decades, not the type where you experience occasional lows, but the kind that prevents you from maintaining employment, creating plans, or even recalling what normalcy feels like. You have attempted thirteen various treatments. None have been effective.
At some point, you cease to inquire, “Will I improve?” and begin to ponder if there is anything at all left to attempt.
For a select few individuals with depression that fails to respond to treatment, there may be a solution: a device roughly the size of a stopwatch, implanted beneath the skin near your chest. It transmits regular electrical signals to your vagus nerve—that thick cluster of nerve fibers extending from your brainstem to your gut. The procedure is known as vagus nerve stimulation, and while it has existed for some time, medical professionals have questioned whether its advantages truly persist. This question has prevented it from becoming a common alternative.
Currently, new insights from the RECOVER trial, recently published in the International Journal of Neuropsychopharmacology, offer the most definitive evidence thus far: for numerous patients, the improvement does not simply diminish. It endures.
The Most Severe Cases Ever Studied
The trial united almost 500 individuals from 84 centers nationwide. These were not individuals experiencing light depression. On average, they had lived with it for 29 years. Three out of four couldn’t sustain employment due to their condition. They had already resorted to an average of 13 different treatments—including major options like electroconvulsive therapy and transcranial magnetic stimulation.
“We believe the sample in this trial represents the most severely treatment-resistant depressed patient group ever examined in a clinical trial,” stated Charles Conway, a psychiatry professor at Washington University School of Medicine in St. Louis who spearheaded the research.
All participants in the trial received the implant, but during the first year, only half had their devices activated. This allowed researchers to compare results between the two groups under controlled conditions. The new analysis focuses on what occurred following that first year—when the effects had ample time to either solidify or, in some cases, surprise everyone.
Among the 214 patients whose devices were activated from day one, approximately 69 percent exhibited genuine improvement after a year. This indicated at least a 30 percent reduction in symptoms, or noticeable enhancements in quality of life or daily functioning. But the critical question was: would it endure?
Indeed. More than 80 percent of those who improved at the one-year mark maintained those benefits—or even progressed further—at the two-year point. For patients who exhibited the strongest responses, with symptoms halved or more, the figures were even more impressive: 92 percent were still faring well two years later.
The Slow Burn Effect
Here’s an unexpected finding that challenges our usual perspectives on psychiatric treatment: nearly one-third of patients who experienced no benefit after a full year of stimulation began to show improvement in the second year. That kind of delayed response is rather uncommon in psychiatry, where we typically assess the efficacy of a treatment within a few months. It suggests the device may influence brain processes that require a significantly longer time to shift than a standard drug trial would wait to evaluate.
Perhaps the most astonishing revelation was full remission. After two years, over 20 percent of participants were essentially devoid of depressive symptoms and functioning normally again. For individuals this severely afflicted, that is truly a remarkable outcome.
This does not imply that vagus nerve stimulation is a miraculous solution. It necessitates surgical intervention. It incurs costs in the tens of thousands of dollars. And it does not benefit everyone. Yet for those who do respond, the advantages appear to persist in a manner few other treatments for severe depression have managed to prove.
The Centers for Medicare and Medicaid Services are currently evaluating the therapy—they currently do not provide widespread coverage. Since private insurers often mirror CMS’s decisions, their verdict could determine whether this treatment remains inaccessible or becomes available to more individuals in need.
For patients like those in RECOVER, individuals Conway refers to as “paralyzed by life”, the most significant measure may not be complete recovery. It might simply be the capacity to maintain improvement once you finally discover it. In that regard, the trial’s consistent steadiness might bear the most significant message: those who improved stayed improved.
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