The purpose of this study is to compare the efficacy of taVNS versus sham stimulation in reduing depressive symptoms in patients with epilepsy.

Inclusion Criteria:

• Adults age ≥18
• Confirmed diagnosis of epilepsy (based on 2014 definition by ILAE)
• Having comorbidity with mild-moderate depression (confirmed diagnosis by a psychiatrist)
• Willing and able to provide informed conset

Exclusion Criteria:

• Those experiencing status epilepticus or frequent seizures requiring emergency medication within the year prior to recruitment
• Those with severe depression or anxiety who are in urgent need of psychiatric care
• Those who are imminently suicidal or unable to keep themselves safe
• Those experiencing severe cognitive difficulties with day-to-day memory, attention, and ability to learn basic information
• Those having a pacemaker, a invasive vagus nerve stimulator, or a metal implant
• The pinna is not suitable for earplugs
• Pregnancy

The device provider assigns the device directly to the patient for training and use after allocation. All the scales will be assessed by the same site assessor, who has undergone consistency training. The doctors, patients, scale assessors and statisticians are all blinded.