Practical considerations in the development and refinement of subcallosal cingulate white matter deep brain stimulation for treatment-resistant depression.

Abstract

Deep brain stimulation has been investigated in the past decade as a viable intervention for treatment-resistant depression. Several anatomic targets have been tested, with the most extensive published experience found for the subcallosal cingulate (SCC) white matter. This article reviews the current state of clinical research of SCC deep brain stimulation for treatment-resistant depression, including an overview of the rationale for targeting SCC, practical considerations for subject recruitment and evaluation, surgical planning, and stimulation parameters. Clinical management of patients in the initial and long-term naturalistic phases of treatment, including the potential role for psychotherapeutic rehabilitation, is discussed.