A clinical study on the augmented therapeutic effects of transcutaneous auricular vagus nerve stimulation combined with repetitive transcranial magnetic stimulation in the treatment of moderate-to-severe depression

Objective: To evaluate the clinical efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of moderate‐to‐severe depression. Methodology: This was a retrospective study. A total of 180 patients diagnosed with moderate‐to‐severe depression and admitted to Hebei Provincial Mental Health Center between July 2023 to March 2025 were enrolled and randomized into three groups(n= 60 each) using a random number table: the taVNS group (Group‐A), the rTMS group (Group‐R) and the taVNS + rTMS group (Group‐C). All patients underwent a 4‐week treatment course. Clinical outcomes, changes in depression severity, sleep quality and incidence of adverse events were assessed post‐treatment. All outcome assessments were conducted under blinded conditions using standardized rating scales. Results: The overall response rate was 85% in Group‐C, significantly higher than the 70% in Group‐A and the 66% in Group‐R (p= 0.02). Additionally, patients in Group‐C showed significantly greater reductions in both Clinical Global Impression and Pittsburgh Sleep Quality Index scores compared with Groups A and R (both p= 0.00). No statistically significant differences were observed among the three groups in the incidence of adverse events(p= 0.60). Conclusion: The combination of taVNS and rTMS demonstrates a synergistic effect in the treatment of moderate‐to‐severe depression, which is considered a safe and effective therapeutic strategy as it can significantly improve clinical symptoms and sleep quality without increasing adverse effects.