Direct electrical stimulation of lateral orbitofrontal cortex acutely improves mood in individuals with symptoms of depression
Open accessAbstract
Mood disorders cause significant morbidity and mortality, and existing therapies fail 20%-30% of patients. Deep brain stimulation (DBS) is an emerging treatment for refractory mood disorders, but its success depends critically on target selection. DBS focused on known targets within mood-related frontostriatal and limbic circuits has been variably efficacious. Here, we examine the effects of stimulation in orbitofrontal cortex (OFC), a key hub for mood-related circuitry that has not been well characterized as a stimulation target. We studied 25 subjects with epilepsy who were implanted with intracranial electrodes for seizure localization. Baseline depression traits ranged from mild to severe. We serially assayed mood state over several days using a validated questionnaire. Continuous electrocorticography enabled investigation of neurophysiological correlates of mood-state changes. We used implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores. We found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. Stimulation suppressed low-frequency power in OFC, mirroring neurophysiological features that were associated with positive mood states during natural mood fluctuation. Stimulation potentiated single-pulse-evoked responses in OFC and modulated activity within distributed structures implicated in mood regulation. Behavioral responses to stimulation did not include hypomania and indicated an acute restoration to non-depressed mood state. Together, these findings indicate that lateral OFC stimulation broadly modulates mood-related circuitry to improve mood state in depressed patients, revealing lateral OFC as a promising new target for therapeutic brain stimulation in mood disorders.
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Rao et al. (2018) showed that iES of the lateral OFC caused improvements in mood in patients with moderate to severe trait depression, whereas iES of medial OFC had no significant effect.
“In general agreement with these findings, recent work by Rao et al. (2018) showed that iES of the lateral OFC caused improvements in mood in patients with moderate to severe trait depression, whereas iES of medial OFC had no significant effect.”
From Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain (2021) · cites this paper as Rao et al., 2018
Stimulation of the ACC produced analogous improvements in mood, although with less consistency than stimulation of OFC.
“Stimulation of the ACC produced analogous improvements in mood, although with less consistency than stimulation of OFC.”
From Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain (2021) · cites this paper as Rao et al., 2018
Many of the sites were in the middle part of the orbitofrontal cortex, areas 13 and 11, which are categorized as medial orbitofrontal cortex, the area activated by rewards.
“many of the sites were in the middle part of the OFC, areas 13 and 11, which are categorized as medial OFC, the area activated by rewards (Rolls, 2019c).”
From The orbitofrontal cortex: reward, emotion and depression (2020) · cites this paper as Rao et al., 2018
Electrical stimulation of the human orbitofrontal cortex can produce reward and raise mood.
“Electrical stimulation of the human OFC can also produce reward and raise mood (Rao et al., 2018)”
From The orbitofrontal cortex: reward, emotion and depression (2020) · cites this paper as Rao et al., 2018
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- Authors
- Rao, V. R., Sellers, K. K., Wallace, D. L., Lee, M. B., Bijanzadeh, M., Sani, O. G., Yang, Y., Shanechi, M. M., Dawes, H. E., & Chang, E. F.
- Affiliations
- University of California, San Francisco (US)
- University of Southern California (US)
- Corresponding author
- Chang, Edward F.
- ORCID
- Venue
- Current Biology
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 28
- Issue
- 24
- Pages
- 3893-3902.e4
- ISSN
- 0960-9822 (ISSN-L)
- OpenAlex
- W2903033387
- Cited by
- 181
- References
- 67
- Citations by year
- 2026: 18 · 2025: 19 · 2024: 23 · 2023: 20 · 2022: 18 · 2021: 26 · 2020: 35 · 2019: 22
- FWCI
- 13.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Current Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Defense Advanced Research Projects Agency (W911NF-14-2-0043)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- lateral orbitofrontal cortex, direct electrical stimulation, depression, mood regulation, deep brain stimulation targets, mood states, epilepsy patients, intracranial electrodes, electrocorticography, low-frequency power, hypomania
- MeSH terms
- Adult, Affect, Depression, Electric Stimulation, Electrodes, Implanted, Epilepsy, Female, Humans, Male, Middle Aged, Deep Brain Stimulation, Young Adult
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