[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Somatic treatments and levels of care](https://durgical.com/en/behavioral-science/areas/care/) › Neuromodulation: TMS, vagus nerve stimulation, deep brain stimulation and light therapy

# 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](https://durgical.com/en/conditions/major-depressive-disorder/) | 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](https://durgical.com/en/conditions/epilepsy-and-seizures/) | 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](https://durgical.com/en/conditions/parkinson-disease/) | 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](https://durgical.com/en/conditions/major-depressive-disorder/) | 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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## Elsewhere in DurgiPedia

- [Parkinsonian syndrome](https://durgical.com/en/clinical-exam/parkinsonian-syndrome/)
- [Parkinson disease and Lewy body disorders](https://durgical.com/en/general-pathology/parkinson-disease-and-lewy-body-disorders/)
- [The limbic system, emotion and reward](https://durgical.com/en/physiology/the-limbic-system-emotion-and-reward/)

## Connections

## Related 3

- [Electroconvulsive therapy](https://durgical.com/en/behavioral-science/electroconvulsive-therapy/)
- [The neurobiology of mental disorders: neurotransmitters and circuits](https://durgical.com/en/behavioral-science/the-neurobiology-of-mental-disorders-neurotransmitters-and-circuits/)
- [How sleep is regulated: sleep pressure, the circadian clock and melatonin](https://durgical.com/en/behavioral-science/how-sleep-is-regulated-sleep-pressure-the-circadian-clock-and-melatonin/)

## Related conditions 6

- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Obsessive-compulsive disorder (OCD)](https://durgical.com/en/conditions/obsessive-compulsive-disorder/)
- [Parkinson disease](https://durgical.com/en/conditions/parkinson-disease/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)
- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)

## In Pharmacology 1

- [Esketamine](https://durgical.com/en/pharmacology/esketamine/)

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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](https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies) (National Institute of Mental Health (NIMH), 2024); [Seasonal Affective Disorder](https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder) (National Institute of Mental Health (NIMH), 2023).

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Source: https://durgical.com/en/behavioral-science/neuromodulation-tms-vagus-nerve-stimulation-deep-brain-stimulation-and-light-the/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/neuromodulation-tms-vagus-nerve-stimulation-deep-brain-stimulation-and-light-the/