![]() Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. ![]() Greenberg B, Gabriels L, Malone D, Rezai A, Friehs G, Okun M, et al. Deep brain stimulation for treatment-resistant depression. Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, et al. I overview recent progress in both those domains, and how it may relate to other technologies discussed in companion articles in this issue. Specifically, I argue that better engagement may come by focusing on the root causes of psychiatric illness: dysfunction in specific, measurable cognitive functions and in the connectivity and synchrony of distributed brain circuits. I review new approaches to psychiatric target engagement, with an emphasis on major depressive disorder (MDD). In psychiatry, those same changes take days to weeks, limiting a clinician’s ability to explore parameter space and identify patient-specific optimal settings. In Parkinson’s, patients’ symptoms change rapidly and visibly when the stimulator is tuned to the correct parameters. The core difference between these clinical applications is the difficulty of proving target engagement, and of leveraging the wide range of possible settings (parameters) that can be programmed in a given patient’s DBS. This contrasts with Parkinson disease, where DBS is an established therapy treating thousands of patients annually. Although it has impressive results in open-label psychiatric trials, DBS has also struggled to scale to and pass through multi-center randomized trials. Deep brain stimulation (DBS) is an invasive approach to precise modulation of psychiatrically relevant circuits.
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