Cited by 542Neurological disorders and treatmentsTranscranial Magnetic Stimulation StudiesTreatment of Major Depression

Targeted electrode-based modulation of neural circuits for depression.

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Mayberg, Helen S.·2009·Journal of Clinical Investigation

Abstract

During the last 20 years of neuroscience research, we have witnessed a fundamental shift in the conceptualization of psychiatric disorders, with the dominant psychological and neurochemical theories of the past now complemented by a growing emphasis on developmental, genetic, molecular, and brain circuit models.Facilitating this evolving paradigm shift has been the growing contribution of functional neuroimaging, which provides a versatile platform to characterize brain circuit dysfunction underlying specific syndromes as well as changes associated with their successful treatment.Discussed here are converging imaging findings that established a rationale for testing a targeted neuromodulation strategy, deep brain stimulation, for treatment-resistant major depression.Depression affects at least 10% of the world population and is a leading cause of worldwide disability (1).Major depressive disorder (MDD) is clinically defined as a multidimensional syndrome, involving disruption of mood, cognition, sensorimotor functions, and homeostatic/drive functions (including those that control sleep, appetite, and libido).While depression can be treated in many cases with either medication or an evidence-based psychotherapy, remission rates in controlled trials using currently available treatments rarely exceed 30%, and relapse is the rule rather than the exception (2).For many patients, combinations of multiple medications and electroconvulsive therapy (ECT) are required.For those who remain severely depressed despite these aggressive approaches, new strategies are needed (3).This Review describes the development and testing of a new interventional strategy, deep brain stimulation (DBS), directed at this group of patients who are otherwise resistant to treatment.Critical to the development of DBS as a new treatment for intractable MDD has been the evolving understanding of the brain circuits that mediate normal and abnormal mood states and the systematic characterization of changes in these circuits that accompany successful and unsuccessful response to various treatments, measured using functional imaging (reviewed in refs.4-8).Based on brain circuit models of depression derived primarily from PET scan measures of glucose metabolism and blood flow, the first region of the brain to be targeted with DBS in patients with treatment-resistant depression (TRD) was the subcallosal cingulate (SCC), the ventral-most segment of the cingulate gyrus (Figure 1).As detailed in the following sections, this region of the brain was considered a critical node within a putative mood regulatory circuit, as it showed the most consistent changes in metabolism and blood flow with clinical recovery, using various well-established antidepressant interventions (9).As such, it was hypothesized that direct stimulation of the SCC and adjacent

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  • In treatment-resistant patients, deep brain stimulation of the subgenual ACC produces marked symptom improvement.

    “demonstrates that in treatment resistant patients, deep brain stimulation in this region causes dramatic symptom improvement (Mayberg et al., 2005(Mayberg et al., , 2009)).”

    From Affective Cognition and its Disruption in Mood Disorders (2011) · cites this paper as Mayberg et al., 2009

  • Spatially specific treatments such as deep brain stimulation or transcranial magnetic stimulation show promise for alleviating treatment-resistant depression, including severe cases.

    “Treatments with enhanced spatial specificity such as deep brain stimulation (DBS) or transcranial magnetic stimulation (TMS), aimed to restore region-specific hypoactivity, show great promise in alleviating treatment-resistant depression in even the most severe cases (2–10).”
  • Depression and anxiety in humans result in part from hypo-activation and reduced volume of frontal cortical and hippocampal regions that control subcortical structures such as NAc and amygdala, although hyper-activation of certain PFC regions is also involved.

    “Numerous studies suggest that depression and anxiety in humans result in part from hypo–activation and reduced volume of frontal cortical and hipppocampal regions that control subcortical structures such as nucleus accumbens (NAc) and amygdala, although hyper–activation of certain PFC regions (e.g., subgenual area of anterior cingulate cortex) is also involved58–61.”

    From Neurobiology of resilience (2012) · cites this paper as [60]

  • Activity in the subcallosal cingulate cortex increases with provocation of sad mood and decreases in response to antidepressant interventions.

    “Activity in this region increases with the provocation of sad mood [16] and decreases in response to antidepressant interventions [16][17][18][19][20].”

    From Deep brain stimulation for depression. (2022) · cites this paper as [17]

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Authors
Mayberg, H. S.
Affiliations
Emory University (US)
Corresponding author
Mayberg, Helen S.
Venue
Journal of Clinical Investigation
Published
2009-04-01
Volume
119
Issue
4
Pages
717-725
ISSN
0021-9738 (ISSN-L)
OpenAlex
W2171752682
Cited by
542
References
127
Citations by year
2026: 17 · 2025: 11 · 2024: 23 · 2023: 21 · 2022: 18 · 2021: 46 · 2020: 27 · 2019: 57 · 2018: 46 · 2017: 31 · 2016: 29 · 2015: 33 · 2014: 40 · 2013: 42 · 2012: 40
FWCI
3.68
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Woodruff Foundation
  • Emory University
  • National Alliance for Research on Schizophrenia and Depression
  • Canadian Institutes of Health Research
  • National Institute of Mental Health
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
deep brain stimulation, treatment-resistant depression, major depressive disorder, subcallosal cingulate, neural circuits, mood regulation, functional neuroimaging, glucose metabolism, cerebral blood flow, antidepressant response
MeSH terms
Antidepressive Agents, Brain, Depression, Electrodes, Electric Stimulation Therapy, Humans, Magnetic Resonance Imaging, Models, Neurological, Nerve Net, Positron-Emission Tomography

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