Deep brain stimulation for treatment-resistant depression

Abstract

Treatment-resistant depression (TRD) is a major cause of disability, with large numbers of patients with depression who either fail to respond or stop responding to conventional treatment approaches. These patients are left with few options after failing psychopharmacological and psychotherapeutic approaches, other than neuromodulation (electroconvulsive therapy or repetitive transcranial magnetic stimulation) and newer treatments such as ketamine and esketamine. Patients with TRD undergo more medication trials and hospitalizations, have higher rates of disability, and have higher rates of suicide. Deep brain stimulation (DBS) in depression has the potential of providing a new treatment to address this serious condition after less invasive strategies have failed. A number of different targets involving modulation of mood neurocircuitry have been investigated in the last 15 years. This chapter will review the history and current evidence of DBS at various targets for the treatment of affective disorders and provide insights into the field.