Frontiers in Invasive and Non-invasive Neuromodulation for Treatment-resistant Psychiatric Disorders

An estimated 30-50% of patients with psychiatric disorders are resistant to both psychotherapy and pharmacological intervention. For these patients, recent advancements in both invasive and non-invasive neuromodulation offer promising therapeutic options. Neurostimulation approaches demonstrate efficacy in targeting large-scale networks and may therefore address dysfunctional circuitry associated with treatment-resistant psychiatric conditions. Among of current neuromodulation approaches, transcranial magnetic stimulation (TMS) is FDA-approved for major depressive disorder, obsessive compulsive disorder and smoking cessation. Deep brain stimulation is currently only approved for obsessive compulsive disorder, while focused ultrasound has yet to be approved for any refractory psychiatric conditions. Increasing evidence suggests that many treatment-resistant psychiatric disorders arise from disruptions in large-scale brain networks. To date, the neural circuitry underlying psychiatric disease is best characterized in OCD, where extensive research has highlighted the role of the cortico-striato-thalamo-cortical circuit. As understanding of disease-specific network dysfunction progresses, both invasive and noninvasive neuromodulation approaches may one day expand to treat other refractory psychiatric disorders, such as eating disorders, Tourette syndrome, substance use disorders, PTSD, and negative symptoms in schizophrenia. Current research aims to identify and characterize network disruptions underly each disorder to guide more precise mapping and subsequent stimulation targeting. In this session, we will discuss several emerging indications for neuromodulation in psychiatry and the common challenges facing clinical teams. Experts will discuss current strategies for optimizing stimulation parameters across modalities, determining when neuromodulation is the appropriate treatment, and identifying predictors of patient response. Additionally, we will discuss advances in understanding the neuronal networks underlying these conditions and how network-level insights can be leveraged to guide more precise and effective targeting strategies. This session will highlight work from multidisciplinary clinical teams spanning neurosurgery, neurology, psychiatry, and engineering.