Deep Brain Stimulation for Treatment-Resistant Depression

About 30% of depressed patients still suffer from considerable residual symptoms despite treatment with established therapies such as antidepressants and psychotherapy. These treatment-resistant depressed (TRD) patients often have severe limitations in their quality of life. New brain stimulation techniques such as deep brain stimulation (DBS) in TRD show in different targets in the brain consistently a positive antidepressant efficacy. Nowadays, the most researched targets of DBS for TRD patients are the internal capsule interna, the subgenuale cingulate cortex (Brodman area, Cg25), the nucleus accumbens and the supero-lateral area of the medial forebrain bundle (supero-lateral branch of the medial forebrain bundle, slMFB). Anhedonia as a core symptom of depression is believed to be most affected by the stimulation of the nucleus accumbens and the slMFB. The fastest and most significant antidepressant effects are shown by the stimulation in the slMFB with a response rate of 85% within a few days.