Deep Brain Stimulation and Depression


About a dozen years ago or so, I was visiting Boston when I got a call from a researcher for 60 Minutes. They had heard that I’d written about experimentation on psychiatric patients (I’d just published Madhouse, about the use of surgical evisceration to cure madness), and they were wondering if I would serve as a consultant for two episodes they were preparing on Deep Brain Stimulation (DBS) as a treatment for depression. I agreed to do so, and spoke with them on a number of occasions over the following months.

I was then invited to New York to be interviewed by Leslie Stahl, and sat with her for about an hour and a half. It was an interesting experience in many ways. I had clearly been invited to participate as the token skeptic on two programs that were going to tout this new magic weapon. Indeed, it subsequently emerged that the plan had been to intercut my comments with those of the Cleveland neurosurgeon who was promoting this modern psychosurgical intervention. I never got to meet him, nor, as it turned out, did I get my 15 minutes of fame — probably just as well.

Leslie Stahl seemed less than thrilled when I pointed out that the “science” behind the notion that depression had a particular location in the brain was dubious in the extreme, and that even with the advantage of modern stereotaxic surgery, the idea that the implantation process was “precise” was an illusion. This was yet another piece of human experimentation being undertaken on the basis of a surgeon’s enthusiasm and some highly speculative claims. Moreover, I pointed out that all the excitement the media were generating about a new miracle cure rested on a handful of anecdotes with no scientific status. Well, Ms. Stahl finally asked, with some asperity, what would I say if those double-blind studies were done, and the procedure worked? I patiently reminded her of why I was extremely skeptical that it would, but said that of course, if it was genuinely and unambiguously shown to relieve the misery of serious depression, and had no major side effects, then I would accept that and welcome it.

We recorded our interview in April, just before the season of summer reruns, so the two planned programs stayed in the can until that fall. And then, a month before the scheduled two-part broadcast, the NBC news magazine broadcast its own puff piece for the procedure. The upshot was that two broadcast programs were cut back to one, and my segment ended up on the cutting room floor — or rather a tiny piece of it ended up on an online version of the program: a tightly edited little fragment that omitted most of my critique and left only the line where I said that if double-blind studies showed it worked, I’d have to eat my skepticism.

As it turned out, those double-blind studies were subsequently undertaken, two of them. Both had extensive funding from industry sources with high hopes of obtaining results that would provide the basis for an extremely lucrative market, and both were undertaken by enthusiasts for the procedure who clearly expected that the trials would endorse the claims previously made based upon open, uncontrolled interventions of this sort.

The first trial was supported by Medtronic, which was already making substantial sums from the use of DBS in Parkinson’s Disease, and saw depression as a huge potential market. Thirty patients were enrolled in a blinded, sham-controlled trial of DBS for sixteen weeks, followed by an open phase. It was, as far as the authors knew, the first such trial to be published, and was prompted by “encouraging response rates” in anecdotal cases.1 “Our results,” the authors report with evident chagrin, “failed to demonstrate a significant difference between the active and the sham-controlled groups during the blinded phase of the study.” Even worse, “psychiatric adverse events . . . were more frequent in the active group than in the control group” including “worsening depression (5 subjects vs 3 subjects), insomnia (4 subjects vs 3 subjects, irritability (3 subjects vs no subjects), suicidal ideation (2 subjects vs no subjects), hypomania (2 subjects vs no subjects), disinhibition (2 subjects vs no subjects), and mania (1 subject vs no subjects). There was one completed suicide among the active treatment group, but since it occurred after the person had stopped treatment because of failure to improve, and was awaiting removal of the electrodes, the authors decided that that adverse event did not count!

All in all, as this recital shows, the trial was an unmitigated disaster. Or, as Darin Dougherty, the lead author of the study later put it, “We fell off a cliff. . . . Given the investments in these pivotal trials, the manufacturers would have to have some awfully compelling reason to revisit these targets . . . from a regulatory standpoint.”2

The second trial was conducted by Helen Mayberg, a neurologist, and Andres Lozano, a neurosurgeon, along with a large team of others. Mayberg and Lozano have long been major cheerleaders for DBS, as they continue to be despite the disastrous results of the trial they ran, which was funded by Abbott/St. Jude Medical. Sixty patients were randomly assigned to active treatment, and 30 to a blinded control group, with the electrodes being implanted in Brodmann area 25, Mayberg and Lozano’s preferred target. The researchers anticipated that those receiving active stimulation would improve twice as much as the control group. The trial was scheduled to last six months, followed by a further six months of open treatment (that is, treatment where everyone knew what was going on). Both treatment and placebo patients improved slightly over the six-month controlled portion of the trial, but the data were unambiguous: “at the end of the 6-month blinded, controlled phase, there was no statistically significant difference in the primary efficacy outcome between the stimulation group . . . and the control group, or in remission.” And six more months in which both groups received stimulation that everyone knew they were getting failed as well. Unsurprisingly, the company funding the trial stopped it.3

Thus, once put to a controlled test, the claims for deep brain stimulation as a treatment for depression resoundingly failed. The purely speculative and fanciful biological “theory” of depression on which the intervention rested had not produced the anticipated results. One might have expected the principals involved to have been suitably chastened, but Mayberg and Lozano were most certainly not. After the failure of the Abbott/St. Jude trial, Mayberg parlayed her prominence in the field into a move from Emory University in Atlanta to a new job. The Icahn School of Medicine at Mount Sinai in New York appointed her as the founding director of the Nash Family Center for Advanced Circuit Therapeutics, lauding her path-breaking research into “brain circuits and for her pioneering deep brain stimulation research,” and promising “precision surgical treatments for neuropsychiatric disorders… to correct brain circuit abnormalities to restore mood as well as motor and cognitive functioning.”4

Of course, “precision” and “brain circuit abnormalities” were public relations phrases devoid of scientific substance. Rather than accepting that the failed controlled studies had undermined this whole set of speculations, Mayberg and her colleagues proceeded to explain them away. Perhaps those enrolled in the trial had been sick for too long. Perhaps the treatment was “less effective for patients with extremely chronic depression.” Maybe the stimulus applied was the wrong one. Or again, “differences in benefit might not be seen until after 1-2 years of treatment in this group.” Or perhaps “gross anatomical placement of electrodes in subcallosal cingulate DBS might not be adequate for optimal treatment delivery.” So, despite the failures, “Subsequent studies are merited.”

Just this week, Dr. Mayberg’s employer issued a press release touting a new paper written by her and her team. It claimed that the new paper of theirs, published online by the American Journal of Psychiatry on October 4, showed that “Deep brain stimulation (DBS) of an area in the brain called the subcallosal cingulate (SCC) provides a robust antidepressant effect that is sustained over a long period of time in patients with treatment-resistant depression.” The paper to which the Mount Sinai medical school refers is an interesting one, but perhaps not precisely in the ways they claim. It is yet another uncontrolled, unblinded study, with a small sample size. Data are cherry-picked and subjected to convoluted statistical analysis that focuses on only a portion of the sample looked at over varying periods of time. The authors seem to have viewed their results through a lens provided by Candide. Inconvenient facts are passed over as quickly as possible. Five of their already small sample dropped out after 1, 2, 5, 8 and 11 years. Then there is a brief but telling paragraph on safety. Among these 28 patients, the authors report 56 serious adverse events. One unfortunate patient was unlucky enough to experience ten of these, and after two years of this medical horror show, had the electrodes removed from his or her brain and dropped out of the study. That leaves another 46 serious adverse events spread among the remaining 27 patients.

What are we talking about here? Nineteen of the events involved the surgery going wrong in a variety of major ways. Six infections resulted from the brain surgery. Six patients had to have the original device “explanted,” as the authors put it, because the wires caused an infection (3 cases), failed to work (2 cases), or the crude targeting of the device needed adjusting (1 case). Another patient experienced hemorrhage of the cortex and a post-operative seizure. The device failed in 15 cases. There is no further discussion of these iatrogenic disasters, or the suffering they entailed. And then, finally, there were the serious psychiatric sequelae. Fourteen of the twenty-eight patients required re-detention in a psychiatric hospital, one on seven occasions, including five admissions occasioned by suicide attempts. What do the authors conclude? “The results here support the long-term safety and sustained efficacy of SCC DBS in an open-label long-term follow-up study.” The subsequent acknowledgement that “it should be emphasized that the absence of a long-term control group . . . precludes firm conclusions regarding the role of chronic DBS in these long-term outcomes” is immediately followed by more happy talk about the wonders of their experiment and the grand future it portends for their version of psychosurgery.5

We have been here before. When the prominent early twentieth-century psychiatrist Henry Cotton decided that the roots of madness lay in chronic untreated toxins hidden in nooks and crannies of the body, he launched a program of “surgical bacteriology.” The program began with the extraction of teeth and tonsils. When patients failed to get better, he believed his theory could not be wrong, so something else must be at work. Like Dr. Mayberg, he sought to explain away his failures and continue excising the biologically defective bits. Patients swallowed. Their stomachs, spleens, and colons thereby became infected. Those organs, or portions thereof, needed to be excised, and so they were. Outside independent but unpublished findings that the upshot was a 44% mortality among those getting abdominal surgery, and that the patients operated upon fared worse than those who escaped Cotton’s attentions, were suppressed by Adolf Meyer of Johns Hopkins, then America’s leading psychiatrist, and Cotton’s mentor. Some of the surgical interventions continued into the 1950s, at the cost of untold patient suffering.6

For well over a century, all sorts of exotic theories have been touted by psychiatrists, and experiments on vulnerable patients have been all too common. My latest book, Psychiatry and Its Discontents, reviews many other episodes of this sort, and the infatuation of the profession with biologically reductionist approaches, heedless of the harms that often accompany them.7 The mantle of science is easily adopted, and those who are skeptical, who warn that the emperor has no clothes, are dismissed as Cassandras, standing in the way of therapeutic progress.

Cotton was lauded in his lifetime by the luminaries of British medicine and psychiatry as psychiatry’s Lister, and invited by Princeton to deliver the prestigious Vanuxem Lectures, in a series graced by many a Nobel Prizewinner. Dr. Mayberg has won many medals for her work, including (remarkably) the Steven Hyman award for neuroethics. She is a member of the prestigious Institute of Medicine — not to mention her occupancy of two major endowed chairs in succession. My conclusion: don’t rely on professions to police themselves, and, most importantly, beware of enthusiasts.

Show 7 footnotes

  1. D.D. Dougherty et al., “A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Chronic Treatment-Resistant Depression,” Biological Psychiatry 78, 2015, 240-248.
  2. Interview in Neurology Today, June 18, 2015.
  3. Paul Holtzheimer et al., “Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Depression: A Multisite, Randomised Sham-Contolled Trial,” Lancet Psychiatry October 4, 2017.
  4. Biography of Helen S. Mayberg, MD,
  5. A. Crowell, P. Riva-Possse, P. Holzheimer, S. Garlow, M. Kelley, R. Gross, L. Denis, S. Quinn, and H. Mayberg, “Long-Term Outcomes of Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Depression,” American Journal of Psychiatry, AJP in Advance (doi: 10.1176/appi.ajp.2019.18121427)
  6. Andrew Scull, Madhouse: A Tragic Tale of Megalomania and Modern Medicine London and New Haven: Yale University Press.
  7. Andrew Scull, Psychiatry and Its Discontents Berkeley and London: University of California Press.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


  1. Thanks for the Article Dr Scull,

    I attended a Western Buddhist Group in London many years ago to learn Buddhist Breathing Meditation, and this has improved my ‘happiness in life’ over the years, very much. I would recommend it to anyone.

    Meditation is something a person can do independently, and the ‘patience’ to do it can be developed very gradually.

    As far as I know Buddhist Breathing Meditation has been reliably ‘proven’ to improve happiness and quality of life.

    Report comment

  2. This is the stuff you get when you believe that depression comes from some localized brain area’s simple malfunctioning, instead of presuming it to be a syndrome that can originate from one or more of a multitude of health related conditions. This seems to be some kind of Adventure in Psycho-neurology where it’s assumed one’s brain works exactly like a computer, where the brain is composed of isolated pieces that can be subjected to control by turning the right ones on and shutting the “wrong” ones off, like doing electrical repairs on your car or an appliance (click, click and all is well).

    Report comment

    • Also notice how it presumes depression to be an independent entity unto itself, and not the result of one or more biological malfunctions that can induce it (also known as a syndrome that requires examination to realize the proper treatment).

      Report comment

        • They likely do, but it’s also likely depressing circumstances can lead to a depressing diet and depressing habits and activities. If I had to do psych first aid and couldn’t find anything I was familiar with, I’d send the individual to you, being too weird to be properly attentive, myself.

          Report comment

          • If psychiatry actually looked for medical issues with the patient, it would be finding a lot of Lyme Disease and a lot of Syphilis – sadly, our lack of screening for Syphilis, an easily treatable antiquated disease, has led to a spike in newborn Syphilis cases! And despite its known neuropsychiatric complications, the latest draft guidelines out of the IDSA recommends against testing psychiatric patients for Lyme Disease. Gotta protect the long term pharmaceutical profits at all costs.

            Report comment

        • My external circumstances are not too different over the years but I’m happier. But a lot of people might be trapped in impossible situations.

          (I remember a doctor friend telling me when someone is in a job that’s full of stress and comes to see him he tells them that the solution might be to leave the job. But a lot of people feel like they can’t, and not necessarily for the money).

          Report comment

  3. This is a very disturbing example of the corruption of mainstream corporate media. According to Pro Publica, every major news franchise except CBS, has at least one board member who also is a Board member of a major pharmaceutical company. The Pro Public report didn’t mention the influence of medical device manufacturing, just big Pharma. Obviously the shareholders of the company developing this this medical device has some kind of major influence with CBS. Someone with excellent research skills should find out what the connection is.

    Report comment

    • Capitalists always work in league with the interests of other capitalists. Most big corporations have many diverse investments. There is no one corporation (media or otherwise) that’s significantly “more corrupt” than any other. In fact “corruption” implies a previous state of integrity; I don’t know when that would have been. (Walter Cronkite?) I guess my point is that Pharma looks out for the interests of Pharma, period; CBS is just one instance. It’s not just one case of a “smoking gun”; the whole plantation reeks of gunpowder, constantly.

      Report comment

  4. Depression cannot be treated because it is not a disease. In all of human history, there has never been even one person who was scientifically proved to feel depressed because of a chemical imbalance in his or her brain. As psychologists Allan Leventhal and Christophe Martell say in their book The Myth of Depression as Disease (p. 58), “It’s not your brain, it’s your life.” As Thomas Szasz wrote in his book The Second Sin (1973), trying to get rid of a so-called mental illness by having a psychiatrist (or whoever) work on your brain is like trying to get cigarette commercials off television by having a TV repairman work on your TV set. All biological treatments for depression are quackery. If there is an exception, it would seem to be marijuana. However, the problem with marijuana, a former user who led a group called Potsmoker’s Anonymous said to me, is it permits you to remain in an unsatisfactory situation in life and do nothing about it. More recently another (probably current) marijuana user told me marijuana makes you not care about what you really should care about. Is this good? Depression tells you something is wrong in your life. Suppressing the pain, even if you can, without fixing the life experience or situation causing it, is counterproductive. For a fuller discussion, see my essay “The Myth of Biological Depression” ( or

    Report comment

    • There are a number of physical depressing things that DON’T involve things in your brain you can localize, but that certainly involve things in the rest of your body that may or may not be localized that are involved in depressed moods. Therapists should be aware of them so their clients won’t wind up in the clutches of people like me- and one of my interests involves others’ treatment failures.

      Report comment

      • Cannabis sativa (marijuana is a slur leftover from reefer madness) is not actually a single uniform substance. Some cannabis has no THC, such as what is termed ‘industrial hemp’. Cannabis in retail stores have many different properties. Some strains have little to no THC while having greater amounts of other cannabinoids and terpenes – each of which produces unique effects in the body. Much of what is available in legal (medical and especially recreational) stores however has very high amounts of THC and almost no detectable amounts of other beneficial cannabinoids and terpenes. When speaking about cannabis, marijuana or weed, one needs to be very clear about the properties of the specific product one is using. Leaving this information out of the discussion means we’re not necessarily talking about the same substance. Unfortunately, this level of education about the plant is not yet well disseminated and so people read (and repeat) misleading headlines like “marijuana causes psychosis” (or laziness) and don’t know that other strains with different chemical compositions actually treat psychosis (or can be stimulating).

        Report comment

  5. As the scientists are not reporting the DBS failures, we have to list and publish them.
    1) Deep Brain stimulation on two anorexia women

    2) Chantal Remeny alive in 2006 given DBS

    Chantal Remeny dead in 2009
    3) A woman named Sheila Cook was claimed to have had successful DBS, but in the long term it did not work. When the DBS failed she willingly(?) received a precise Lobotomy /Anterior Cingulotomy .

    Report comment

  6. I was looking for the words fraud or corruption to describe the trials but didn’t see them. That would imply criminal activity. Since Mad in America purports to be “for social justice” why no examination of the Government’s role in corporate funded brain experimentation? We have a tale of damaged patients and negative results “laundered” by medical professionals and corporations yet no one seems to be able to do anything about it but write an op-ed for social media.

    Report comment

  7. Andrew

    Great blog and exposure of the enormous harm caused by the Medical Model of so-called “treatment” for human psychological distress.

    This system cannot be reformed, and must be eliminated along with the profit based system of capitalism that created this oppressive model and continues to benefit in many ways from its existence.

    Question: is there any scientific evidence that DBS provides any help to people with Parkinson’s disease?


    Report comment

  8. Here is an article about someone from my neck of the woods.

    It seems this man was ‘helped’. Of course this will take of like wildfire now.
    I regret that his addiction is called a “brain ILLNESS”. We all, every single one of us has a unique brain, receptors, dopamine, etc etc ec. We do not know what causes one to get addicted, or depressed or what have you, as opposed to another.
    IF science presented these new pills and gadgets as sheer attempt, with loads of possible side effects, and an absolute uncertainty (which it is) and not based on seeing the brain as “dysfunction” or “ill” or “diseased”
    If they presented the absolute truths within their attempts, I could understand psychiatry and we would all be informed properly.
    The treatment “worked” for this Doctor, but what else was affected within the brain? Something was because the brain is not neatly divided.

    If science and shrinks said “we invented this new thing, we obviously have no clue if it will work without touching any other part of who you are, since we know little about the brain, and in truth, it most likely will effect other parts”
    If they said “we do not know the brain, and we cannot call behaviour an “illness”, but if you have something that is bothersome, we can try and help with our rudimentary theories”

    The big problem is that it has always been the DSM, the “sickness”, “disorders”, “illness” part and the lies, theories presented as something factual.
    It makes no more sense than assumptions that our arms should all be the same length.
    Everyone understands the fascination about other people and behaviour. Psychiatry could simply come clean and start stating the truth, not present their judgments and absorptions, obsessions as a bible to live by.

    We still don’t know exactly why he quit drinking.

    Report comment