Deep brain stimulation: A narrative review of its applicability for major depressive disorder.

Abstract

Objectives: This article reviews the existing literature on DBS in the context of MDD, with particular attention to treatment-resistant depression (TRD), and provides a comprehensive, up-to-date overview of its mechanisms, efficacy, and potential challenges.

Background: Deep brain stimulation (DBS) has established itself as an effective intervention for movement disorders, such as Parkinson's disease, in which stimulation of structures including the subthalamic nucleus and the internal globus pallidus provides significant symptom relief. In recent years, its application has been increasingly explored in psychiatric disorders, particularly major depressive disorder (MDD). However, a substantial proportion of patients do not respond adequately to conventional treatments and are classified as having treatment-resistant depression (TRD). DBS has recently been approved by the Food and Drug Administration (FDA) for treatment-resistant obsessive-compulsive disorder (OCD), while its potential role in MDD-especially in TRD-remains under investigation.

Methods: Through a qualitative, exploratory analysis based on bibliographic searches, this study aims to inform and update academics and healthcare professionals on recent discoveries and applications of DBS in the treatment of MDD and TRD, thereby advancing science and improving public health and social well-being.

Results: Existing studies have investigated several neural targets involved in mood regulation, including the subgenual cingulate cortex, subthalamic nucleus, globus pallidus, and, in exploratory models, the amygdala. Available evidence suggests that modulation of these circuits may contribute to improvements in depressive symptoms in treatment-resistant cases, although variability in study design, patient selection, and stimulation parameters remains significant.

Conclusions: DBS represents a promising but still evolving therapeutic strategy for treatment-resistant depression. Further research is needed to refine targeting strategies, optimize stimulation protocols, and better establish long-term efficacy and safety.