Deep Brain Stimulation (DBS), the targeted modulation of discrete neural circuits using implanted electrodes, is an emerging experimental treatment strategy for patients with intractable major depression. To date, surgical implantation of DBS leads has relied on high-resolution structural images to localise the stimulation target followed by trial-and-error behavioural testing at individual contacts. As use of this technology has matured, imaging continues to play a crucial role, with recent work focused on refinement and optimisation of the procedure using multimodality modelling of structural and functional connections along specific white matter tracts combined with real-time behavioural and electrophysiological metrics. Further, imaging biomarkers are being pursued to define patient subtypes most likely to benefit. Together these studies offer a unique perspective on critical pathways and mechanisms mediating antidepressant effects of DBS, and on the pathophysiology of treatment resistant depression more generally.
Prof. Helen Mayberg, MD is a Professor of Psychiatry, Neurology and Radiology and the Dorothy Fuqua Chair in Psychiatric Neuroimaging and Therapeutics at Emory University. Over the last 25 years, her interdisciplinary depression research team has worked to integrate cutting-edge imaging strategies, quantitative behavioural and psychophysiological metrics, and experimental treatment trials to define brain-based biomarkers that can optimise treatment selection for individual patients.