Targeting distinct facets of anhedonia via transcutaneous auricular vagus nerve stimulation: Effects on heart rate variability and reward-based behavior

Anhedonia, a core feature of major depressive disorder, is associated with disrupted reward processing and may represent a mechanistically relevant target for neuromodulation. This study examined the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on reward-related behavior and autonomic regulation in individuals with higher (n = 34) and lower (n = 34) depressive symptomatology. In a randomized, within-subject crossover design, participants received active taVNS and sham stimulation on two separate days. During each session, incentive motivation and reward learning were assessed using the Effort Expenditure for Rewards Task and the Probabilistic Reward Task (PRT), respectively, with stimulation condition and task order counterbalanced. Findings revealed that taVNS effects on heart rate variability (HRV) were modulated by baseline HRV levels and depressive status; specifically, they enhanced HRV at low baseline levels and reduced it at high baseline levels in participants with lower depressive symptomatology, with opposite patterns in individuals with higher symptoms. Moreover, compared to sham, taVNS enhanced the willingness to exert effort for rewards, particularly at low reward probabilities, with a more pronounced effect in the group characterized by higher depressive symptoms. No significant effects were observed on reward learning, as indexed by the PRT. Additionally, taVNS reduced self-reported anxiety across groups. Despite the limitation of a single stimulation session, these findings suggest that taVNS modulates motivational effort allocation in individuals with higher depressive symptoms, supporting its potential relevance for targeting reward-related dysfunctions in mood disorders.