Shaping plasticity with non-invasive brain stimulation in the treatment of psychiatric disorders: Present and future.

The final chapter of this book addresses plasticity in the setting of treating psychiatric disorders. This chapter largely focuses on the treatment of depression and reviews the established antidepressant brain stimulation treatments, focusing on plasticity and maladaptive plasticity. Depression is a unique neuropsychiatric disease in that the brain goes from a healthy state into a pathologic state, and then, with appropriate treatment, can return to health often without permanent sequelae. Depression thus differs fundamentally from neurodegenerative brain diseases like Parkinson's disease or stroke. Some have theorized that depression involves a lack of flexibility or a lack of plasticity. The proven brain stimulation methods for treating depression cause plastic changes and include acute and maintenance electroconvulsive therapy (ECT), acute and maintenance transcranial magnetic stimulation (TMS), and chronically implanted cervical vagus nerve stimulation (VNS). These treatments vary widely in their speed of onset and durability. This variability in onset speed and durability raises interesting, and so far, largely unanswered questions about the underlying neurobiological mechanisms and forms of plasticity being invoked. The chapter also covers exciting recent work with vagus nerve stimulation (VNS) that is delivered paired with behaviors to cause learning and memory and plasticity changes. Taken together these current and future brain stimulation treatments for psychiatric disorders are especially promising. They are unlocking how to shape the brain in diseases to restore balance and health, with an increasing understanding of how to effectively and precisely induce therapeutic neuroplastic changes in the brain.