Deep brain stimulation for treatment-resistant depression: Predicting response and optimizing treatment

Depression has been increasingly recognized as a systems-level disorder; thus, treatments that target critical brain regions in order to influence the function of brain circuits are an important area of study. Deep brain stimulation (DBS), a therapeutic modality initially used in movement disorders, was first applied to treatment-resistant depression (TRD) in 2005. Multiple groups around the world have treated several hundred TRD patients with DBS on an investigational basis. There is no current single accepted protocol for DBS in TRD; variation is possible both in anatomic site and stimulation parameters. The purpose of this article is to discuss the current state of knowledge for DBS in TRD as it relates to patient selection, anatomic target selection and optimization, and stimulation parameters.