Targeted electrode-based modulation of neural circuits for depression
Helen S. Mayberg
Helen S. Mayberg
Published April 1, 2009
Citation Information: J Clin Invest. 2009;119(4):717-725. https://doi.org/10.1172/JCI38454.
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Targeted electrode-based modulation of neural circuits for depression

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.

Authors

Helen S. Mayberg

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Figure 4

Selective targeting of the depression circuit with DBS in patients with TRD.

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Selective targeting of the depression circuit with DBS in patients with ...
(A) Preoperative (pre-op) MRI demonstrating the intended anatomical location for the DBS electrode within the SCC white matter. The four individual contacts on the electrode (numbered 1–4) can be independently stimulated using a programmable implanted pulse generator. (B) Preoperative blood flow PET scan demonstrating baseline hyperactivity of the SCC in the TRD study group (n = 6) relative to healthy controls. (C) The postoperative (post-op) MRI with the electrodes in place within the SCC white matter. (D) Six-month blood flow change relative to preoperative baseline associated with chronic DBS of the optimal SCC contact in four DBS responders. Red indicates increased blood flow and blue indicates decreased blood flow. hth, hypothalamus; MCC, mid-cingulate cortex; sn, substantia nigra; vCd, ventral caudate (adapted with permission from Neuron [ref. 11]).