- Numbers
- Extremely common with a lifetime prevalence of 15-20%,
- 30% of patients not responding to standard medications or psychotherapy.
- The management of treatment-resistant depression includes
- Repeated trials of medication,
- Psychotherapy, and
- Forms of brain stimulation (transcranial magnetic stimulation and electroconvulsive therapy).
- However, there is a significant subgroup of patients (10-20%) who remain chronically treatment refractory, and relapse and development of resistance to ECT also poses problems.
- Targets for DBS applications in
- Based on
- Extrapolation from sites targeted in lesional psychosurgical procedures
- From the results of neuroimaging experiments.
- White matter adjacent to the subgenual anterior cingulate
- Anterior limb of the internal capsule
- Associated ventral capsule/ventral striatum (including the nucleus accumbens).
- Less commonly described targets include
- Superolateral branch of the median forebrain bundle
- Inferior thalamic peduncle
- Lateral habenula
- See VNS for depression
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