The TRANSCEND study evaluates Abbott's DBS system for treatment-resistant depression (TRD), granted FDA Breakthrough Device designation. A multi-centered, double-blind, randomized, sham-controlled trial plans to enroll 100 participants, aged 22-70, who have failed at least 4 antidepressant treatments. Success is measured by improvements in Montgomery-Asberg Depression Rating Scale (MADRS) scores after 12 months, with all participants having DBS turned on for an additional 2 years. Challenges include patient selection, target brain circuit identification, and maintaining response over time.