Neuromodulation for Depression

Neuromodulation (also known as neurostimulation) is a growing and important category of treatments for depression. First-line treatments such as pharmacotherapy and counseling often fail to achieve remission, and neuromodulation can help many such patients. Neuromodulatory techniques can be broadly divided into invasive approaches, which include deep brain stimulation, epidural cortical stimulation, and vagal nerve stimulation, and noninvasive approaches, which include electroconvulsive therapy, transcranial magnetic stimulation, theta burst stimulation, and transcranial direct-current stimulation, among others. While efficacy varies among techniques, those with the most efficacy tend to be those that target nodes of a proposed tripartate functional connected circuit that includes left dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, and vagus nerve. Treatments currently being developed that hold promise include accelerated intermittent theta burst stimulation and low-intensity focused ultrasound pulsation.