The Targets of Deep Brain Stimulation in the Treatment of Treatment-Resistant Depression: A Review

IF 2.6 3区心理学 Q2 BEHAVIORAL SCIENCES

Brain and Behavior Pub Date : 2025-05-05 DOI:10.1002/brb3.70505

Jianyang Dong, Mengying Dai, Zinan Guo, Ting Xu, Fangming Li, Jianjun Li

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Abstract

Purpose

The purpose of this review is to evaluate the current state and potential future directions of deep brain stimulation (DBS) therapy for treatment-resistant depression (TRD), a condition that significantly impacts patients' quality of life and for which conventional treatments are often ineffective.

Method

This review synthesizes evidence from clinical trials and preclinical studies published in five years, identified through PubMed searches using keywords (“Deep Brain Stimulation” OR DBS) AND (“Treatment-Resistant Depression” OR TRD). Included studies encompassed clinical research (randomized/non-randomized trials, cohort studies) and mechanistic preclinical studies, excluding non-English publications and nonhuman experiments. Screening prioritized neuroanatomical targets (e.g., SCG, NAcc) and stimulation parameter optimization data. Examining the therapeutic mechanisms of DBS, the neuroanatomical targets utilized, and the clinical outcomes observed. It also discusses the challenges faced in DBS application and proposes potential technological advancements, such as closed-loop therapy and fiber tracking technology.

Finding

Preliminary evidence exists regarding the efficacy and safety of DBS in the treatment of TRD in the subcortical cingulate gyrus (SCG), nucleus accumbens (NAcc), ventral capsule/ventral striatum (VC/VS), anterior limb of the internal capsule (ALIC), and so forth. Nevertheless, the optimal stimulation target remains undetermined. The review highlights the complexity of TRD and the need for personalized treatment strategies, noting that genetic, epigenetic, and neurophysiological changes are implicated in DBS's therapeutic effects.

Conclusion

In conclusion, while DBS for TRD remains an experimental therapy, it offers a unique and potentially effective treatment option for patients unresponsive to traditional treatments. The review emphasizes the need for further research to refine DBS targets and parameters, improve patient selection, and develop personalized treatment plans to enhance efficacy and safety in TRD management.

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脑深部电刺激治疗难治性抑郁症的研究进展

目的本综述的目的是评估脑深部电刺激（DBS）治疗难治性抑郁症（TRD）的现状和潜在的未来方向，这一疾病严重影响患者的生活质量，常规治疗往往无效。方法本综述综合了近五年来发表的临床试验和临床前研究的证据，这些证据是通过PubMed检索关键词（“深部脑刺激”或DBS）和（“治疗难治性抑郁症”或TRD）确定的。纳入的研究包括临床研究（随机/非随机试验，队列研究）和机械性临床前研究，不包括非英语出版物和非人体实验。筛选优先的神经解剖学靶点（如SCG、NAcc）和刺激参数优化数据。探讨DBS的治疗机制、使用的神经解剖学靶点和观察到的临床结果。讨论了DBS应用中面临的挑战，并提出了潜在的技术进步，如闭环治疗和光纤跟踪技术。DBS治疗皮层下扣带回（SCG）、伏隔核（NAcc）、腹侧囊/腹侧纹状体（VC/VS）、内囊前肢（ALIC）等部位TRD的有效性和安全性存在初步证据。然而，最佳刺激目标仍未确定。这篇综述强调了TRD的复杂性和个性化治疗策略的必要性，并指出遗传、表观遗传和神经生理变化与DBS的治疗效果有关。综上所述，尽管DBS治疗TRD仍是一种实验性治疗方法，但它为对传统治疗无反应的患者提供了一种独特且潜在有效的治疗选择。该综述强调需要进一步研究以完善DBS靶点和参数，改进患者选择，制定个性化治疗计划，以提高TRD管理的有效性和安全性。

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来源期刊

Brain and Behavior BEHAVIORAL SCIENCES-NEUROSCIENCES

CiteScore

5.30

自引率

0.00%

发文量

352

审稿时长

14 weeks

期刊介绍： Brain and Behavior is supported by other journals published by Wiley, including a number of society-owned journals. The journals listed below support Brain and Behavior and participate in the Manuscript Transfer Program by referring articles of suitable quality and offering authors the option to have their paper, with any peer review reports, automatically transferred to Brain and Behavior. * [Acta Psychiatrica Scandinavica](https://publons.com/journal/1366/acta-psychiatrica-scandinavica) * [Addiction Biology](https://publons.com/journal/1523/addiction-biology) * [Aggressive Behavior](https://publons.com/journal/3611/aggressive-behavior) * [Brain Pathology](https://publons.com/journal/1787/brain-pathology) * [Child: Care, Health and Development](https://publons.com/journal/6111/child-care-health-and-development) * [Criminal Behaviour and Mental Health](https://publons.com/journal/3839/criminal-behaviour-and-mental-health) * [Depression and Anxiety](https://publons.com/journal/1528/depression-and-anxiety) * Developmental Neurobiology * [Developmental Science](https://publons.com/journal/1069/developmental-science) * [European Journal of Neuroscience](https://publons.com/journal/1441/european-journal-of-neuroscience) * [Genes, Brain and Behavior](https://publons.com/journal/1635/genes-brain-and-behavior) * [GLIA](https://publons.com/journal/1287/glia) * [Hippocampus](https://publons.com/journal/1056/hippocampus) * [Human Brain Mapping](https://publons.com/journal/500/human-brain-mapping) * [Journal for the Theory of Social Behaviour](https://publons.com/journal/7330/journal-for-the-theory-of-social-behaviour) * [Journal of Comparative Neurology](https://publons.com/journal/1306/journal-of-comparative-neurology) * [Journal of Neuroimaging](https://publons.com/journal/6379/journal-of-neuroimaging) * [Journal of Neuroscience Research](https://publons.com/journal/2778/journal-of-neuroscience-research) * [Journal of Organizational Behavior](https://publons.com/journal/1123/journal-of-organizational-behavior) * [Journal of the Peripheral Nervous System](https://publons.com/journal/3929/journal-of-the-peripheral-nervous-system) * [Muscle & Nerve](https://publons.com/journal/4448/muscle-and-nerve) * [Neural Pathology and Applied Neurobiology](https://publons.com/journal/2401/neuropathology-and-applied-neurobiology)