Practical considerations in the development and refinement of subcallosal cingulate white matter deep brain stimulation for treatment-resistant depression

Abstract

Background: Deep brain stimulation has been investigated in the past decade as a viable intervention for treatment-resistant depression.

Methods: Several anatomic targets have been tested, with the most extensive published experience found for the subcallosal cingulate (SCC) white matter.

Results: This article reviews the current state of clinical research of SCC deep brain stimulation for treatment-resistant depression, including an overview of the rationale for targeting SCC, practical considerations for subject recruitment and evaluation, surgical planning, and stimulation parameters.

Conclusion: Clinical management of patients in the initial and long-term naturalistic phases of treatment, including the potential role for psychotherapeutic rehabilitation, is discussed.

Trial registration: ClinicalTrials.gov NCT00367003.

Keywords: BA; Brodmann area; DBS; Deep brain stimulation; ECT; Electroconvulsive therapy; MDD; Major depressive disorder; NAcc; Nucleus accumbens; SCC; Subcallosal cingulate; Subcallosal cingulated; TRD; Treatment-resistant depression; VC/VS; Ventral capsule/ventral striatum.