Deep Brain Stimulation for Treatment-Resistant Depression

BACKGROUND: Major depressive disorder is a common and disabling illness and is the leading cause of disability worldwide. Despite aggressive medical, behavioral, and electroconvulsive therapies, a significant number of patients remain refractory to treatment. Deep brain stimulation (DBS) has proven efficacy in neurobehavioral disorders and, in a general sense, works by modulation of corticostriatopallidothalamocortical circuits implicated in these disorders. METHODS: Current data, treatment rationales, and future directions are presented. RESULTS: The two targets most commonly used for DBS in treatment-resistant depression are the subgenual cingulate gyrus and the ventral capsule/ventral striatum. Data on DBS of these regions are preliminary, with promise shown in early studies. CONCLUSIONS: Early work suggests DBS may become a therapeutic option in treatment-resistant depression. Further study is justified given the immense burden of disease.