Cingulate dynamics track depression recovery with deep brain stimulation

Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) can provide long-term symptom relief for treatment-resistant depression (TRD). However, achieving stable recovery is unpredictable, requiring trial-and-error stimulation adjustments. This study used a new device enabling electrophysiology recording to deliver SCC DBS to ten TRD participants. At 24 weeks, 90% showed robust clinical response, and 70% achieved remission. Using SCC local field potentials, an explainable artificial intelligence approach identified LFP changes indicating the patient's clinical state. This biomarker is sensitive to therapeutic adjustments and accurately captures individual recovery states. Recovery trajectories are predicted by preoperative damage to the white matter treatment network and matched by objective facial expression changes. Results demonstrate the utility of objective biomarkers in personalized SCC DBS management and provide insight into the relationship between multifaceted features of TRD pathology.

Sankaraleengam Alagapan, Ki Sueng Choi, Stephen Heisig, Patricio Riva-Posse, Andrea Crowell, Vineet Tiruvadi, Mosadoluwa Obatusin, Ashan Veerakumar, Allison C. Waters, Robert E. Gross, Sinead Quinn, Lydia Denison, Matthew O'Shaughnessy, Marissa Connor, Gregory Canal, Jungho Cha, Rachel Hershenberg, Tanya Nauvel, Faical Isbaine, Muhammad Furqan Afzal, Martijn Figee, Brian H. Kopell, Robert Butera, Helen S. Mayberg, Christopher J. Rozell