Research Article

The Combined Effect of Noisy Galvanic Vestibular Stimulation and Virtual Reality Vestibular Rehabilitation on Symptoms and Vestibular Function in female Patients with Major Depressive Disorder: A Controlled study with randomized intervention arms

nGVS and VR Rehabilitation in Major Depressive Disorder

Abstract

Background and Aim: Major depressive disorder (MDD) is associated with dizziness, balance complaints, and abnormalities in vestibular processing. This study examined whether noisy galvanic vestibular stimulation (nGVS), virtual reality (VR)-based vestibular rehabilitation, or their combination, when added to stable pharmacotherapy, could influence depressive symptoms, dizziness-related disability, and vestibular function in women with moderate MDD. We hypothesized that the combined intervention would be associated with greater improvement than vestibular intervention or pharmacotherapy alone.
Methods: This controlled quasi-experimental study included 52 women with moderate MDD. A separately recruited non-randomized control group (n=13) received pharmacotherapy alone. The 39 participants were randomly allocated to nGVS, VR, or nGVS+VR groups (n=13 each). nGVS consisted of three 20-minute sessions once weekly for three weeks. VR-based vestibular rehabilitation comprised eight 45-minute sessions twice weekly over four weeks. Pharmacotherapy remained unchanged during the intervention and follow-up periods. Assessments were performed at baseline, post-intervention, and one-month follow-up.
Results: Depressive symptoms decreased more in the nGVS+VR and VR groups than in the control group post-intervention and in all vestibular intervention groups at follow-up. Between-group changes in dizziness-related disability were not statistically significant. Right lateral canal vestibulo-ocular reflex (VOR) gain showed greater improvement in the combined group compared with the control group.
Conclusion: Vestibular-targeted interventions added to stable pharmacotherapy were associated with greater improvement in depressive symptoms. The combined intervention produced a selective improvement in right lateral VOR gain. These preliminary findings warrant further investigation but do not establish generalized vestibular recovery or superiority of the combined approach across all outcomes.

1. Otte C, Gold SM, Penninx BW, Pariante CM, Etkin A, Fava M, et al. Major depressive disorder. Nat Rev Dis Primers. 2016;2:16065. [DOI:10.1038/nrdp.2016.65]
2. .Balaban CD, Jacob RG. Background and history of the interface between anxiety and vertigo. J Anxiety Disord. 2001;15(1-2):27-51. [DOI:10.1016/s0887-6185(00)00041-4]
3. Omara A, Basiouny EM, Shabrawy ME, Shafei RR. The correlation between anxiety, depression, and vertigo: a cross-sectional study. Egypt J Otolaryngol. 2022;38:143. [DOI:10.1186/s43163-022-00318-7]
4. Kim CH, McCray LR, Nguyen SA, Staab JP, Jafri S, Rizk H. Anxiety and Depression in Adults with Vestibular Disorders: A Systematic Review and Meta-Analysis. Laryngoscope. 2026;136(2):535-46. [DOI:10.1002/lary.70055]
5. Soza Ried AM, Aviles M. Asymmetries of vestibular dysfunction in major depression. Neuroscience. 2007;144(1):128-34. [DOI:10.1016/j.neuroscience.2006.09.023]
6. Soza AM, Certanec B, Tapia E. Abnormal vestibular asymmetries in patients with major depression. Asia Pac J Clin Trials Nerv Syst Dis. 2018;3(2):36-42. [DOI:10.4103/2542-3932.232075]
7. Hitier M, Besnard S, Smith PF. Vestibular pathways involved in cognition. Front Integr Neurosci. 2014;8:59. [DOI:10.3389/fnint.2014.00059]
8. Lopez C, Blanke O. The thalamocortical vestibular system in animals and humans. Brain Res Rev. 2011;67(1-2):119-46. [DOI:10.1016/j.brainresrev.2010.12.002]
9. Balaban CD. Vestibular nucleus projections to the parabrachial nucleus in rabbits: implications for vestibular influences on the autonomic nervous system. Exp Brain Res. 1996;108(3):367-81. [DOI:10.1007/BF00227260]
10. Halberstadt AL, Balaban CD. Serotonergic and nonserotonergic neurons in the dorsal raphe nucleus send collateralized projections to both the vestibular nuclei and the central amygdaloid nucleus. Neuroscience. 2006;140(3):1067-77. [DOI:10.1016/j.neuroscience.2006.02.053]
11. Curthoys IS, Macdougall HG. What galvanic vestibular stimulation actually activates. Front Neurol. 2012;3:117. [DOI:10.3389/fneur.2012.00117]
12. Pasquier F, Denise P, Gauthier A, Bessot N, Quarck G. Impact of Galvanic Vestibular Stimulation on Anxiety Level in Young Adults. Front Syst Neurosci. 2019;13:14. [DOI:10.3389/fnsys.2019.00014]
13. Pires APBÁ, Silva TR, Torres MS, Diniz ML, Tavares MC, Gonçalves DU. Galvanic vestibular stimulation and its applications: a systematic review. Braz J Otorhinolaryngol. 2022;88 Suppl 3(Suppl 3):S202-11. [DOI:10.1016/j.bjorl.2022.05.010]
14. Freher NK, van Bennekom M, Bexkens A, Veling W, Bockting CLH. Virtual Reality in the treatment of depression; what therapeutic strategies does VR target? J Affect Disord Rep. 2025;20:100912. [DOI:10.1016/j.jadr.2025.100912]
15. Lee M, Jang S, Shin HK, Choi SW, Kim HT, Oh J, et al. Virtual Reality-Based Cognitive Behavior Therapy for Major Depressive Disorder: An Alternative to Pharmacotherapy for Reducing Suicidality. Yonsei Med J. 2025;66(1):25-36. [DOI:10.3349/ymj.2024.0002]
16. Giguère S, Potvin S, Fortier A, Phraxayavong K, Lespérance F, Do A, et al. Virtual reality-based Avatar Therapy for treatment-resistant major depressive disorder: A pilot study. Psychiatry Res. 2026;360:117080. [DOI:10.1016/j.psychres.2026.117080]
17. Lorkowski J, Raulinajtys-Grzybek M, Pokorski M. Virtual Reality-Based Rehabilitation Therapy. Physiol Res. 2025;74(4):563-9. DOI:10.33549/physiolres.935590]
18. de Andrade PHS, Henrique MESA, Roza AEG, Luvizutto GJ, de Souza LAPS. Virtual reality-enhanced vestibular exercises versus conventional rehabilitation for peripheral vestibular dysfunction rehabilitation: a systematic review and meta-analysis. Phys Ther Rev. 2025;30(4):253-60. [DOI:10.1080/10833196.2025.2514386]
19. Hasimova Z, Sahbaz T, Karacay BC, Karan A. Effectiveness of virtual reality therapy in chronic unilateral vestibular hypofunction: A randomized controlled study. Turk J Phys Med Rehabil. 2023 Jul 7;69(3):286-293. DOI: 10.5606/tftrd.2023.12360
20. Lacour M, Bernard-Demanze L. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery. Front Neurol. 2015;5:285. [DOI:10.3389/fneur.2014.00285]
21. Khavarghazalani B, Adel Ghahraman M, Hoseinabadi R, Jalaie S, Kouhi A, Yazdani N. Combining vestibular rehabilitation and noisy galvanic vestibular stimulation for treatment of unilateral vestibulopathy: a randomized controlled trial. Aud Vestib Res. 2023;32(4):272-83. [DOI:10.18502/avr.v32i4.13591]
22. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92. [DOI:10.1002/da.20070]
23. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci. 2014;19(8):769-75.
24. McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The Video Head Impulse Test (vHIT) of Semicircular Canal Function - Age-Dependent Normative Values of VOR Gain in Healthy Subjects. Front Neurol. 2015;6:154. [DOI:10.3389/fneur.2015.00154]
25. Heidari Sharifabad Z, Hajiabolhassan F, Hoseinabadi R, Faezi ST, Jalaie S. Assessment of saccular and semicircular canal function in Behcet's disease. Aud Vestib Res. 2022;31(4):249-63. [DOI:10.18502/avr.v31i4.10729]
26. Brunoni AR, Lopes M, Kaptchuk TJ, Fregni F. Placebo response of non-pharmacological and pharmacological trials in major depression: a systematic review and meta-analysis. PLoS One. 2009;4(3):e4824. [DOI:10.1371/journal.pone.0004824]
27. 27.Wittmeyer Cedervall L, Magnusson M, Karlberg M, Fransson PA, Nyström A, Tjernström F. vHIT Testing of Vertical Semicircular Canals With Goggles Yield Different Results Depending on Which Canal Plane Being Tested. Front Neurol. 2021;12:692196. [DOI:10.3389/fneur.2021.692196]
28. 28.Cuccurazzu B, Halberstadt AL. Projections from the vestibular nuclei and nucleus prepositus hypoglossi to dorsal raphe nucleus in rats. Neurosci Lett. 2008;439(1):70-4. [DOI:10.1016/j.neulet.2008.04.094]
29. 29.Filatova EV, Shadrina MI, Slominsky PA. Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells. 2021;10(6):1283. [DOI:10.3390/cells10061283]
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Keywords
: Major Depressive Disorder Vestibular Rehabilitation Galvanic Vestibular Stimulation Virtual Reality vestibulo-ocular reflex video head impulse test.
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Hajiabolhassan F, Lotfi Y, Khodaei Ardakani M, Bakhshi E. The Combined Effect of Noisy Galvanic Vestibular Stimulation and Virtual Reality Vestibular Rehabilitation on Symptoms and Vestibular Function in female Patients with Major Depressive Disorder: A Controlled study with randomized intervention arms. Aud Vestib Res. 2026;.