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Major depressive disorder represents one of the most severe disabling disorders, affecting around 4.7% of the worldwide population. Many patients suffering this neuropsychiatric illness are treated successfully with various treatments, including antidepressant drugs and psychotherapy but also physical measures (electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagal nerve stimulation). Despite the different treatment approaches available, unfortunately 30–40% of the patients fail to respond to most first-line treatments, and between 5 and 10% do not respond to conventional therapy at all. Thus, a considerable number of patients have a poor outcome and unfortunately fail to reach sustained remission. These data highlight the need to find new therapeutic approaches that especially focus on refractory patients. In this context, deep brain stimulation (DBS) emerges as an innovative physical treatment for refractory depressed patients. DBS has been successfully used for years in some neurological disorders such as Parkinson's disease. Currently, in addition to its use in treating depression, DBS is also being tested in other psychiatric illness such as obsessive–compulsive disorder. Most studies on DBS have focused on efficiency and efficacy, or improvement in the technique, and a few were devoted to understanding the intrinsic mechanisms responsible. Understanding the molecular mechanisms of action of DBS is currently considered as crucial, not only in order to understand its efficacy but also to propose new antidepressant approaches. The aim of this chapter is to review the foundations, the efficacy, and the efficiency of DBS in depression, and to provide insight into the intrinsic mechanisms of action described until now. In addition, future developments will be discussed.

DOI: 10.1007/978-3-319-53126-7_19

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