Depression in humans: The ventral capsule/ventral striatum

Abstract

The use of deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) for the treatment of major depressive disorder (MDD) stems from pioneering work in obsessive–compulsive disorder. Understanding the rationale for the VC/VS target chosen for investigation of MDD requires an appreciation of the neuroanatomical structures and their positioning relative to each other. Presently, there are no consensus guidelines or algorithms for DBS patient selection, surgical implantation, or programming in depression. DBS of the VC/VS for the treatment of depression remains investigational and not approved by the Food and Drug Administration. With our experience over the past decade in 16 patients who underwent DBS electrode implantation at the VC/VS for the treatment of depression at our clinic, we have been able to delineate trends and common responses that may assist in the programming of this population. The development of this emerging therapy depends on advances in neurosurgical technique and patient selection, as well as furthering our understanding of the circuitry involved in the targeted region.