Major depressive episodes are the largest cause of psychiatric disability, and can often resist treatment with medication and psychotherapy. Advances in the understanding of the neural circuit basis of depression, combined with the success of deep brain stimulation (DBS) in movement disorders, spurred several groups to test DBS for treatment-resistant depression. Multiple brain sites have now been stimulated in open-label and blinded studies. Initial open-label results were dramatic, but follow-on controlled/blinded clinical trials produced inconsistent results, with both successes and failures to meet endpoints. Data from follow-on studies suggest that this is because DBS in these trials was not targeted to achieve physiologic responses. We review these results within a technology-lifecycle framework, in which these early trial "failures" are a natural consequence of over-enthusiasm for an immature technology. That framework predicts that from this "valley of disillusionment," DBS may be nearing a "slope of enlightenment." Specifically, by combining recent mechanistic insights and the maturing technology of brain-computer interfaces (BCI), the next generation of trials will be better able to target pathophysiology. Key to that will be the development of closed-loop systems that semi-autonomously alter stimulation strategies based on a patient's individual phenotype. Such next-generation DBS approaches hold great promise for improving psychiatric care.
Bibliographical noteFunding Information:
Preparation of this work was supported in part by grants from the Brain & Behavior Research Foundation (AW), National Institutes of Health (MH109722, AW; MH111320 and NS100548, AW and DD), and Defense Advanced Research Projects Agency (Cooperative Agreement W911NF-14-2-0045, AW and DD). The views, opinions, and/or findings expressed are those of the author(s) and should not be interpreted as representing the official views or policies of any sponsor or funding source.
© 2018 Widge, Malone and Dougherty.
- Brain circuits
- Brain-computer interfaces
- Deep brain stimulation