{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:18:16Z","timestamp":1791332296973,"version":"4.3.1"},"reference-count":106,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive\u2013compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB\u2019s (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING\/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.<\/jats:p>","DOI":"10.3390\/brainsci12040438","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T15:31:21Z","timestamp":1648222281000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["\u201cThe Heart Asks Pleasure First\u201d\u2014Conceptualizing Psychiatric Diseases as MAINTENANCE Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive\u2013Compulsive Disorder"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1703-6283","authenticated-orcid":false,"given":"Volker A.","family":"Coenen","sequence":"first","affiliation":[{"name":"Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"},{"name":"Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Schlaepfer","sequence":"additional","affiliation":[{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"},{"name":"Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Department of Interventional Biological Psychiatry, Medical Center of University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian E. A.","family":"Sajonz","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Reinacher","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"},{"name":"Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-2252","authenticated-orcid":false,"given":"M\u00e1t\u00e9 D.","family":"D\u00f6br\u00f6ssy","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"},{"name":"Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Reisert","sequence":"additional","affiliation":[{"name":"Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany"},{"name":"Medical Faculty, Freiburg University, 79106 Freiburg, Germany"},{"name":"Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center of University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.neubiorev.2012.11.015","article-title":"Emotional Valence Modulates Brain Functional Abnormalities in Depression: Evidence from a Meta-Analysis of FMRI Studies","volume":"37","author":"Groenewold","year":"2013","journal-title":"Neurosci. 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