Connectomic DBS in major depression

Deep brain stimulation (DBS) for depression has been investigated in the past decade as a potential intervention for which no reasonable treatment options are available. Multiple groups worldwide have tested several anatomic targets and have reported safety and benefit from DBS for treatment-resistant depression (TRD) in open-label studies. However, the therapeutic effects of either short-term and long-term DBS vary as a function of respective targets and stimulation parameters and also according to clinical characteristics of individual patients. Advanced imaging techniques and computational neural network modeling allow us to evaluate the use of connectomic DBS, with a shift from relatively simple anatomical localization of the stimulation target to a more comprehensive visualization of a targeted brain network. The subcallosal cingulate region (SCC) is the most studied target thus far for TRD, and it evolved over successive experimental cohorts along just such a trajectory: from a regional target to a network target. In this chapter, we will offer insights into the evolution of SCC DBS from anatomy-based to connectome-based targeting for treating major depression.