Deep brain stimulation (DBS) is currently used successfully in a limited group of patients with major depression or obsessive-compulsive disorder. But this treatment may be able to help many more patients. Researcher and psychiatrist in training Gosse Mol: “Depression can manifest itself in many different ways in patients. There are all sorts of ideas about which ’type’ of depression can or cannot be treated well with deep brain stimulation. Because of this, many patients are currently still excluded from DBS.” Research from Amsterdam UMC now shows that these ideas are wrong, because no factors are known that can predict the effect of DBS in patients with depression. This means that DBS could potentially be used more broadly.

When people have tried (almost) all regular treatments for depression, deep brain stimulation may still be able to help. Deep brain stimulation (DBS) is an advanced treatment used for neurological and psychiatric disorders. Through implanted electrodes, electrical signals are delivered to specific brain regions to regulate brain activity. Within psychiatry, DBS is primarily used in patients with obsessive-compulsive disorder or severe depression.  Patients who did not recover sufficiently after any previous treatment, experience – on average – a large decrease in symptoms after DBS. Nevertheless, DBS is still very little used in psychiatry.

Predictions

Researchers at Amsterdam UMC investigated whether the effect of DBS in people with depression can be predicted in advance. To do so, they analysed 7,766 scientific articles and 22 studies with data from 294 patients. Their analysis shows that there are no strong factors that can reliably predict whether or not DBS will be effective. Currently, it is often assumed that DBS will not help patients, but this assumption is not based on scientific research, this study shows.
Gosse Mol stresses the importance of diligence in selecting patients with depression for DBS: “In some studies, hundreds of people are assessed for eligibility, but the vast majority of them are excluded. We found no evidence that the selected characteristics were predictive of treatment success.”

Excluding patients

Gosse Mol cautions that excluding patients based on assumptions is risky. “The results of this study do not mean that there are no characteristics that can predict whether DBS is successful in patients with depression, but rather that we do not yet know which characteristics they are. If we exclude so many people, we won’t be able to investigate that further either.” At Amsterdam UMC, therefore, each patient is carefully examined. “We always make the decision whether or not to treat with DBS in close consultation with the patient, family and previous practitioners who know the patient well,” Mol said.

Source: Amsterdam UMC (in Dutch)

Gosse J.J. Mol, Nora Runia, Guido A. van Wingen, Damiaan Denys, Roel J.T. Mocking, Isidoor O. Bergfeld. Pre-operative predictors of response to deep brain stimulation in depression: A systematic review and meta-analysis. Journal of Affective Disorders, Volume 388, 2025, 119387, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2025.119387.

Access publication here: Pre-operative predictors of response to deep brain stimulation in depression: A systematic review and meta-analysis – ScienceDirect