The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Vagus nerve stimulation for treatment-resistant depression.


Depression is associated with feelings of sadness, despair, helplessness, hopelessness and lack of interest in life. People with severe depression may be unable to eat or sleep or to take part in social activities, and they may become completely withdrawn. Vagus nerve stimulation aims to improve mood regulation and reduce depression by stimulating the nerve in the neck that carries signals to the brain areas involved. A generator implanted under the skin in the chest area is used to provide electrical stimulation to the nerve.

Coding recommendations

A33.1 Introduction of neurostimulator into cranial nerve
Z04.4 Vagus nerve (x)

In addition an ICD-10 code from category F32 Depressive episode or F33 Recurrent depressive disorder is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)