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 2

Theoretical time course of mood circuit changes during a depressive episode.

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Theoretical time course of mood circuit changes during a depressive epis...
Functional neuroimaging abnormalities are viewed as the net effect of a triggering event and subsequent intrinsic adaptive or maladaptive responses, in other words, failure to self-correct. The nature of these compensatory changes is considered critical for understanding clinical symptom heterogeneity and clinical subtypes of MDD, providing a potential future framework for the development of brain-based algorithms for treatment selection based on distinct circuit patterns or brain phenotypes (indicated here as scan types i–iv). By example, scan type i, characterized by maladaptive overcorrection of the circuit, might be optimally treated with CBT. In contrast, failure to initiate or sustain any adaptive response, as defined here by scan type iv, might require ECT or DBS.