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It is almost 15 years since the first proof-of-principle report of DBS for treatment resistant depression. Progress continues, with implementation of refined techniques for surgical targeting and emerging clues as to which patients are most likely to benefit. Additional perspectives on trajectory, time-course, and sustainability of DBS effects have been advanced by device innovations that address mechanisms at the neural level. Current studies are further poised to explore strategies to maximize rehabilitative gains of patients once the DBS itself is optimized. Together, these studies provide a unique opportunity to form a more comprehensive and nuanced understanding of illness and recovery.