DBS (deep brain stimulation), also known as a brain pacemaker, is a surgical neuromodulation method used to treat Parkinson's disease, dystonia, and certain other movement disorders. In recent years, whether this method may also be beneficial for patients with very severe depression that does not respond to standard treatments has been investigated.
However, an important point should be emphasized from the outset: DBS is not currently a standard or routine treatment for depression. The method is still considered experimental and is used primarily within the scope of scientific research [1,2].
What Is Treatment-Resistant Depression?
Various methods, such as antidepressant medications, psychotherapy, electroconvulsive therapy, and transcranial magnetic stimulation, may be used to treat depression.
In some patients, significant improvement cannot be achieved despite multiple treatments administered at an adequate dose and duration. This condition may be defined as treatment-resistant depression. However, the definition may vary depending on the criteria used and the study.
Patients enrolled in DBS studies are generally individuals who have experienced severe depression for many years and have not obtained sufficient benefit from numerous standard treatments.
What Does DBS Target in Depression?
Depression is not thought to arise from a single “dysfunctional center” in the brain. Many brain regions related to mood, motivation, reward perception, attention, and decision-making function as interconnected networks.
The purpose of DBS is not to activate a “happiness center,” but to regulate the functioning of brain networks associated with depression.
Targets being investigated include:
- The subcallosal or subgenual cingulate region,
- The ventral capsule–ventral striatum,
- The nucleus accumbens,
- The medial forebrain bundle
.
However, it has not been established which target is most effective or which patient is more likely to respond better to a particular target [1,3].
What Do Scientific Studies Show?
The results of DBS studies for depression are not entirely consistent with one another.
In small, open-label studies and long-term follow-up, significant and sustained improvements have been reported in some patients. However, because both the patient and the physician know that stimulation is active in open studies, these results alone cannot definitively demonstrate the true effect of DBS [2,4].
In a multicenter, randomized, placebo-controlled study published in 2017, subcallosal cingulate DBS was not shown to have a significant advantage over sham stimulation during the six-month blinded period [2].
In another randomized, double-blind study published in 2025, no significant treatment difference was found between periods of active and inactive stimulation during the blinded phase. In contrast, during the open-label follow-up period in which all patients received active stimulation, depressive symptoms decreased over time; response rates among evaluable patients were reported as approximately 65.7% at month 12, 69.0% at month 18, and 73.1% at month 24 [1].
These results can be interpreted in two ways:
First, it is possible that the effect of DBS emerges slowly in some patients and that blinded periods of several months are insufficient to evaluate the treatment.
Second, some of the improvement observed during open-label follow-up may be related to close monitoring, expectancy effects, concurrent treatments, or natural clinical fluctuations.
Therefore, although current research suggests that DBS may be beneficial in some patients, the effectiveness of the method for depression has not yet been definitively proven.
Does the Effect Occur Immediately?
The potential effect of DBS in depression is generally not as rapid as its motor effects in Parkinson's disease.
In some patients, changes in energy, attention, or emotional response may be observed during surgery or in the first days of stimulation. However, it may take weeks or months for a sustained antidepressant effect to emerge.
Long-term follow-up has reported that improvement continues for years in some patients. However, not every patient responds, and it is not possible to reliably predict in advance who will respond [4].
Is DBS That Listens to Brain Signals Possible?
Traditional DBS systems deliver continuous stimulation using predetermined settings. New research, however, is moving toward closed-loop systems that detect brain signals associated with the patient's depressive symptoms and provide stimulation only when needed.
In a study published in 2021, a personalized closed-loop system was used in a single patient with severe, treatment-resistant depression. The researchers identified a patient-specific brain signal and programmed the device to provide brief stimulation when this signal emerged. Rapid and sustained clinical improvement was reported in the patient [5].
However, this study included only one patient. Therefore, it cannot be said that the method will have the same effect in other patients.
In another study published in 2023, a brain signal that could track the process of recovery from depression was investigated in patients receiving subcallosal cingulate DBS. Although the study is important for enabling more objective and personalized DBS programming in the future, it is not a study that by itself proves the effectiveness of the treatment [6].
Is Every Patient With Severe Depression a Candidate for DBS?
No.
DBS is an invasive surgical procedure that requires electrodes to be placed in the brain. It carries risks such as infection, bleeding, seizures, device problems, and stimulation-related neuropsychiatric changes.
Before a patient is evaluated for DBS within the scope of research:
- The diagnosis of depression should be confirmed in detail,
- It should be assessed whether previous treatments were actually administered at an adequate dose and duration,
- Bipolar disorder, psychotic disorders, substance use, and personality characteristics should be evaluated,
- Suicide risk should be carefully addressed,
- The patient's adherence to the long-term follow-up and programming process should be evaluated.
This decision should be made by an experienced team in which psychiatry, functional neurosurgery, neuropsychology, and other relevant specialties work together.
Does DBS Completely Cure Depression?
Current scientific evidence does not show that DBS definitively eliminates depression or prevents it from recurring.
The goal of DBS is to reduce symptoms, improve functioning, and enhance quality of life in highly selected patients. Medication, psychotherapy, or other psychiatric treatments may need to continue after DBS.
Conclusion
DBS for depression is a scientifically important and promising area of research. Although long-term and significant improvements have been reported in some patients, the results of randomized and placebo-controlled studies are not yet consistent.
Therefore, it is not appropriate to present DBS as a proven treatment or a miraculous solution for depression.
For now, the most accurate description is:
DBS is a neuromodulation method being investigated for very severe, treatment-resistant depression that is becoming increasingly personalized but remains experimental.
References
- 1. Giacobbe P, Rizvi SJ, Ceniti AK, et al. Deep brain stimulation to the subgenual cingulate gyrus for treatment-resistant depression: a randomized controlled trial and 2-year long-term follow-up. Can J Psychiatry. 2026;71:266–276. doi:10.1177/07067437251369226.
- 2. Holtzheimer PE, Husain MM, Lisanby SH, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial. Lancet Psychiatry. 2017;4:839–849. doi:10.1016/S2215-0366(17)30371-1.
- 3. Wu Y, Mo J, Sui L, et al. Deep brain stimulation in treatment-resistant depression: a systematic review and meta-analysis on efficacy and safety. Front Neurosci. 2021;15:655412. doi:10.3389/fnins.2021.655412.
- 4. Crowell AL, Riva-Posse P, Holtzheimer PE, et al. Long-term outcomes of subcallosal cingulate deep brain stimulation for treatment-resistant depression. Am J Psychiatry. 2019;176:949–956. doi:10.1176/appi.ajp.2019.18121427.
- 5. Scangos KW, Khambhati AN, Daly PM, et al. Closed-loop neuromodulation in an individual with treatment-resistant depression. Nat Med. 2021;27:1696–1700. doi:10.1038/s41591-021-01480-w.
- 6. Alagapan S, Choi KS, Heisig S, et al. Cingulate dynamics track depression recovery with deep brain stimulation. Nature. 2023;622:130–138. doi:10.1038/s41586-023-06541-3.