Neuromodulation: TMS, vagus nerve stimulation, deep brain stimulation and light therapy

Technique

Treatments that change brain activity with magnetic pulses, implanted stimulators or bright light, used mainly when depression or OCD resist usual care.

Updated Nov 13, 2026

Key points

rTMS: magnetic pulses over the prefrontal cortex; no anaesthesia, patient awake, daily sessions about five days a week for 4–6 weeks; for treatment-resistant depression and OCD.
rTMS side effects are mild (scalp discomfort, mild headache); seizures are possible but low risk.
VNS: a device implanted in the upper left chest stimulates the left vagus nerve; developed for epilepsy and approved for treatment-resistant depression; side effects include hoarseness, cough and sore throat.
DBS: electrodes implanted in the brain with a generator in the upper chest; developed for Parkinson disease and other movement disorders, cleared for severe treatment-resistant OCD, still experimental for depression.
Bright light therapy: daily sessions in front of a bright light box, usually in the morning, from fall to spring; used mainly for winter-pattern seasonal depression.
Unlike ECT, rTMS does not need anaesthesia and is not meant to cause a seizure.

What it is

Neuromodulation treats mental disorders by acting directly on brain circuits rather than with a medicine. Repetitive transcranial magnetic stimulation (rTMS) uses a coil on the scalp to deliver magnetic pulses to areas such as the left prefrontal cortex, with no anaesthesia, for treatment-resistant depression, OCD and smoking dependence. Vagus nerve stimulation (VNS) and deep brain stimulation (DBS) need surgery: VNS for treatment-resistant depression (and epilepsy), DBS mainly for Parkinson disease and other movement disorders, and for severe treatment-resistant OCD. Bright light therapy is used mainly for winter-pattern seasonal depression.

How it is done

Confirm the diagnosis and that adequate trials of medicines and psychotherapy failed (light therapy is used early for winter-pattern seasonal depression).
Screen risks: seizure risk (rTMS), surgical risk (VNS, DBS), certain eye diseases or light-sensitizing medicines (light therapy).
rTMS: sessions are given about five days a week for 4–6 weeks; shorter accelerated schedules also exist.
VNS and DBS: surgical implantation, then adjustment of stimulation over follow-up visits.
Light therapy: a daily session in front of the light box, usually each morning, from fall to spring.
Track symptoms with a rating scale and review the plan if there is no improvement.

Neuromodulation methods compared

Method	How it works	Main uses	Main side effects
Repetitive TMS	Magnetic coil on the scalp induces currents in areas such as the left prefrontal cortex	Treatment-resistant depression, OCD; also smoking dependence and migraine	Scalp discomfort, mild headache; seizures possible but low risk
Vagus nerve stimulation	Device in the upper left chest stimulates the left vagus nerve	Treatment-resistant depression, epilepsy	Hoarseness, cough, sore throat, infection, device problems
Deep brain stimulation	Electrodes implanted in the brain, generator in the upper chest	Parkinson disease and other movement disorders; severe resistant OCD; depression experimental	Bleeding in the brain, stroke, infection
Bright light therapy	Daily bright light from a light box, usually in the morning	Winter-pattern seasonal depression	Caution with some eye diseases or light-sensitizing medicines
Magnetic seizure therapy	Magnetic coil induces a seizure under anaesthesia	Experimental for resistant depression	Fewer memory and other cognitive effects than ECT in a systematic review

Test yourself

Think of the answer, then tap the question to see it.

What is the main serious risk of rTMS?

A seizure, which is possible but low risk; most side effects are mild scalp discomfort and headache.

For which psychiatric disorder is deep brain stimulation used outside research?

Severe, treatment-resistant OCD; its main established use is Parkinson disease and other movement disorders.

What is the main use of bright light therapy?

Winter-pattern seasonal depression: daily sessions in front of a bright light box, usually in the morning, from fall to spring; CBT adapted for seasonal depression and antidepressants are also used.

Which nerve is stimulated in VNS, and on which side?

The left vagus nerve, through a device implanted in the upper left chest.

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Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Brain Stimulation Therapies (National Institute of Mental Health (NIMH), 2024); Seasonal Affective Disorder (National Institute of Mental Health (NIMH), 2023).

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