Closing the Loop on Deep Brain Stimulation for Treatment-Resistant Depression
Abstract
Introduction: Circuit-Directed Treatments for Circuit Illnesses
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Development and Initial Trials of DBS for Depression
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BOX 1. Summary of Inclusion/Exclusion Criteria Across MDD DBS Trials. MADRS, Montgomery-Asberg Depression Rating Scale. HAMD, Hamilton Depression Rating Scale. ECT, Electro-Convulsive Therapy.
Serendipity
Imaging
Theory
Scientific Lessons from Clinical-Endpoint “Failures”
DBS Involves Multiple Strong Placebos
Detecting Clinical Signal Requires Extended Treatment
Sites Must be Prepared for Long-Term Care
Symptom Heterogeneity May Cloud Trial Results
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Commercial Viability Requires Greater Reliability
Toward Closed-Loop DBS: Emerging Insights and Platform Technologies
Phenotyping and Diagnostics
Connecting Anatomy to Physiologic Effects
Platforms for Longitudinal Physiologic Monitoring
Improved Efficacy From Next-Generation Technologies
Conclusions
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