Deep Brain Stimulation for Treatment-Resistant Mental Illness

Abstract

A large fraction of patients with mental disorders obtain no relief from medications, psychotherapy, or noninvasive treatments. For these patients, deep brain stimulation (DBS) may be an option. DBS is a surgical therapy that places electrodes precisely into specific brain structures (targets). It has evidence for clinical efficacy from open-label studies in obsessive-compulsive disorder and major depressive disorder. In both disorders, more than 50% of otherwise refractory patients obtain meaningful benefit. At the same time, DBS has not yet passed a large, well-controlled, multisite trial. This is in part because the devices are complex to program, such that many patients do not receive an adequate “therapy” dose. New technologies may overcome that complexity, either through precision mapping of a patient's individual brain anatomy or by directly measuring the electrical activity of key brain structures and titrating DBS to change that activity. [ Psychiatr Ann . 2022;52(7):283–287.]