Effects of acute transcutaneous vagus nerve stimulation on emotion recognition in adolescent depression

Julian Koenig, Peter Parzer, Niklas Haigis, Jasmin Liebemann, Tamara Jung, Franz Resch, Michael Kaess, Julian Koenig, Peter Parzer, Niklas Haigis, Jasmin Liebemann, Tamara Jung, Franz Resch, Michael Kaess

Abstract

Background: Transcutaneous vagus nerve stimulation (tVNS) is a promising therapeutic option for major depressive disorder (MDD) in adults. Alternative third-line treatments for MDD in adolescents are scarce. Here we aimed to assess the effects of acute tVNS on emotion recognition in adolescents with MDD.

Methods: Adolescents (14-17 years) with MDD (n = 33) and non-depressed controls (n = 30) received tVNS or sham-stimulation in a cross-sectional, case-control, within-subject cross-randomized controlled trial, while performing different tasks assessing emotion recognition. Correct responses, response times, and errors of omission and commission on three different computerized emotion recognition tasks were assessed as main outcomes. Simultaneous recordings of electrocardiography and electro dermal activity, as well as sampling of saliva for the determination of α-amylase, were used to quantify the effects on autonomic nervous system function.

Results: tVNS had no effect on the recognition of gradually or static expressed emotions but altered response inhibition on the emotional Go/NoGo-task. Specifically, tVNS increased the likelihood of omitting a response toward sad target-stimuli in adolescents with MDD, while decreasing errors (independent of the target emotion) in controls. Effects of acute tVNS on autonomic nervous system function were found in non-depressed controls only.

Conclusions: Acute tVNS alters the recognition of briefly presented facial expressions of negative valence in adolescents with MDD while generally increasing emotion recognition in controls. tVNS seems to specifically alter early visual processing of stimuli of negative emotional valence in MDD. These findings suggest a potential therapeutic benefit of tVNS in adolescent MDD that requires further evaluation within clinical trials.

Keywords: Adolescents; depression; emotion recognition; vagus nerve stimulation.

Figures

Fig. 1.
Fig. 1.
Illustration of the study design; the study comprised two appointments. Diagnostic assessments were conducted at T1. The actual experiment, including the neuropsychological tasks, was conducted at T2. Illustrated are the tVNS/sham stimulation periods (randomized order across participants); recording periods for electrocardiography (ECG), electrodermal activity (EDA) as well as function near infrared spectroscopy (fNIRS); and time points of saliva sampling and self-reports on current affective states (PANAS).
Fig. 2.
Fig. 2.
Schematic illustration of the placement of the ear electrode; (a) active transcutaneous vagus nerve stimulation; the ear electrode is placed in contact with the skin of the left concha; (b) sham stimulation; the ear electrode is placed in contact with the left ear lobe, not innervated by the vagus nerve.
Fig. 3.
Fig. 3.
Main effects of tVNS on emotion recognition (hits and omission errors) in the emotional Go/NoGo-task by group; hits, correct responses toward target-stimuli in percent (total of 128 stimuli per condition); omission errors, no reaction toward a target stimulus (go-trial) in percent; tVNS, transcutaneous vagus nerve stimulation at the concha of the left outer ear; sham, sham-stimulation of the left ear lobe; MDD, adolescents with major depression; control, non-depressed adolescents; illustrated are means and 95% confidence intervals.
Fig. 4.
Fig. 4.
Effects of tVNS on emotion recognition (hits and omission errors) in the emotional Go/NoGo-task by target emotion and group; hits, correct responses toward target-stimuli in percent (total of 64 stimuli per condition and emotion); omission errors, no reaction toward a target stimulus (go-trial) in percent (%); tVNS, transcutaneous vagus nerve stimulation at the concha of the left outer ear; sham: sham-stimulation of the left ear lobe; MDD, adolescents with major depression; control, non-depressed adolescents; go-negative, target stimuli presenting faces with sad expressions; go-positive, target stimuli presenting faces with happy expressions; illustrated are means and 95% confidence intervals.
Fig. 5.
Fig. 5.
Linear associations between effects of tVNS and measures of a clinical outcome; illustrated are changes in omission errors under tVNS (delta score: sham – tVNS) in association with the respective clinical outcome in the full sample. omission errors, no reaction toward a target stimulus (go-trial) in percent (%); CDRS, Children's Depression Rating Scale – Revised; BDI, Beck Depression Inventory II; DERS, Difficulties in Emotion Regulation; CGAS, Children's Global Assessment Scale; blue dots: patients with MDD, gray dots: non-depressed controls.

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