Deep Brain Stimulation (DBS): What It Is and How It's Used

What Is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a surgical treatment in which a surgeon places thin electrodes into specific areas of the brain through small openings in the skull (Mahoney et al., 2022). These electrodes are connected by a wire to a small device called a pulse generator, which is implanted under the skin — usually near the collarbone or in the abdomen (Mahoney et al., 2022; Jakobs et al., 2023).

The pulse generator works much like a pacemaker for the brain. Some versions use a battery that eventually needs to be surgically replaced, while others are rechargeable and simply need to be charged periodically, similar to charging a phone (Jakobs et al., 2023).

Once a person has recovered from surgery, their care team programs the device — adjusting the strength, frequency, and pattern of the electrical pulses to find the settings that work best for that individual (Mahoney et al., 2022). Because DBS can target very specific brain regions, it can also be fine-tuned over time as a person's needs change (Cleary et al., 2015).

What Conditions Does DBS Treat?

DBS has been used and studied for decades, primarily as a treatment for movement disorders. It's approved by the U.S. Food and Drug Administration (FDA) for several conditions, including Parkinson's disease, essential tremor, dystonia, and treatment-resistant epilepsy (Mahoney et al., 2022).

The part of the brain that's targeted depends on the condition. For example, treatment for Parkinson's disease and dystonia focuses on areas called the internal globus pallidus and subthalamic nucleus, while treatment for tremor targets a different region called the thalamus (Holtzheimer & Mayberg, 2011).

Fine-tuning the device tends to be more straightforward for movement disorders, since doctors can directly observe changes in movement. Adjusting DBS for psychiatric conditions is more complex, since the effects on mood and thinking are harder to measure in real time (Mahoney et al., 2022).

DBS as a Treatment for Mental Health Conditions

The idea of using brain stimulation to treat psychiatric conditions actually dates back to the 1950s, although very little research was published at the time (Holtzheimer & Mayberg, 2011). Interest picked up again after a 1999 study explored DBS as a treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD) (as cited in Holtzheimer & Mayberg, 2011).

In this context, a condition is described as "treatment-resistant" (or "treatment-refractory") when standard therapies — medication, psychotherapy, or both — haven't adequately relieved a person's symptoms (Mahoney et al., 2022). Since that early research, scientists have continued to study DBS as a possible option for people with severe OCD and depression who haven't responded to more conventional treatments.

DBS and Obsessive-Compulsive Disorder (OCD)

OCD involves distressing, unwanted thoughts (obsessions) paired with repetitive behaviors (compulsions) that a person feels driven to perform, often to relieve the anxiety the obsessions cause (Mahoney et al., 2022). Standard treatment usually combines medication — commonly a class of antidepressants called SSRIs — with psychotherapy, particularly cognitive behavioral therapy (CBT) (Mahoney et al., 2022).

OCD affects an estimated 2–3% of people at some point in their lives, and standard treatments don't bring adequate relief for roughly a quarter to nearly half of those diagnosed (Mahoney et al., 2022). In 2009, the FDA approved DBS for severe, treatment-resistant OCD under what's called a humanitarian device exemption — a special approval pathway for treatments that address rare conditions and have been shown not to pose unreasonable risk, even though they aren't held to the same evidence standards as fully approved treatments (Wu et al., 2021).

Research so far suggests DBS can help people with OCD who haven't found relief through other means. That said, it's a significant intervention: it carries surgical risks, is costly, and requires ongoing follow-up care (Wu et al., 2021). Researchers are still working to better understand which patients are most likely to benefit, which brain targets work best, and how much stimulation is needed (Mahoney et al., 2022).

DBS and Depression

Major depressive disorder (MDD) involves persistent low mood and/or loss of interest or pleasure, often alongside changes in energy, concentration, sleep, appetite, and self-esteem, and in more severe cases, thoughts of suicide (Holtzheimer & Mayberg, 2011). It's one of the most common mental health conditions worldwide and a leading cause of disability (Holtzheimer & Mayberg, 2011). In 2020, an estimated 8.4% of adults in the U.S. experienced at least one depressive episode (National Institute of Mental Health [NIMH], 2022).

Standard treatments include psychotherapy (such as CBT) and medications like SSRIs (Zhou et al., 2018). However, about 30% of people with MDD don't respond adequately to these approaches (Mahoney et al., 2022), and treatment-resistant depression is associated with higher rates of disability, hospitalization, and suicide risk (Crowell et al., 2019).

Because of this, researchers have explored other options. Several clinical trials have found ketamine to be effective for treatment-resistant depression, and two other FDA-approved options — transcranial magnetic stimulation (TMS) and vagus nerve stimulation — are also used for this purpose (Mahoney et al., 2022; Crowell et al., 2019).

DBS has been studied as well. Researchers have identified several brain regions that appear to function differently in people with depression, including the subcallosal cingulate cortex, the nucleus accumbens, and the medial forebrain bundle — and these are the areas typically targeted in DBS research for depression (Cleary et al., 2015). A 2018 review of the research found that DBS improved depressive symptoms overall (Zhou et al., 2018), and a 2019 study found that DBS targeting the subcallosal cingulate cortex was safe and effective long-term for people with depression and bipolar II disorder (Crowell et al., 2019).

Overall, current research suggests DBS can be an effective option for treatment-resistant depression, though more studies are needed before it becomes a widely approved treatment (Mahoney et al., 2022).

Is DBS Right for You?

DBS is just one of several emerging and established options for people facing serious mental health challenges — it isn't the right fit for everyone, and it's typically considered only after other treatments haven't worked. If you or someone you love is struggling with symptoms of depression, OCD, or another mental health condition, reach out to a licensed mental health provider to help you understand your options.

References

Cleary, D. R., Ozpinar, A., Raslan, A. M., & Ko, A. L. (2015). Deep brain stimulation for psychiatric disorders: Where we are now. Neurosurgical Focus, 38(6), E2. https://doi.org/10.3171/2015.3.FOCUS1546

Crowell, A. L., Riva-Posse, P., Holtzheimer, P. E., Garlow, S. J., Kelley, M. E., Gross, R. E., Denison, L., Quinn, S., & Mayberg, H. S. (2019). Long-term outcomes of subcallosal cingulate deep brain stimulation for treatment-resistant depression. The American Journal of Psychiatry, 176(11), 949–956. https://doi.org/10.1176/appi.ajp.2019.18121427

Holtzheimer, P. E., & Mayberg, H. S. (2011). Deep brain stimulation for psychiatric disorders. Annual Review of Neuroscience, 34, 289–307. https://doi.org/10.1146/annurev-neuro-061010-113638

Jakobs, M., Hajiabadi, M. M., Aguirre-Padilla, D. H., Giaccobe, P., Unterberg, A. W., & Lozano, A. M. (2023). Recharge PSYCH: A study on rechargeable implantable pulse generators in deep brain stimulation for psychiatric disorders. World Neurosurgery, 170, e331–e339. https://doi.org/10.1016/j.wneu.2022.11.017

Mahoney, J. J., 3rd, Koch-Gallup, N., Scarisbrick, D. M., Berry, J. H., & Rezai, A. R. (2022). Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment. Journal of the Neurological Sciences, 437, 120253. https://doi.org/10.1016/j.jns.2022.120253

National Institute of Mental Health. (2022, January). Major depression. https://www.nimh.nih.gov/health/statistics/major-depression

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