What matters in next-generation implanted neurotechnology design? Perspectives from individuals with treatment-refractory depression.

Objective. Major financial investments in implanted neurotechnology have fueled a wave of innovation in device design, implant procedures and therapy delivery methods. These innovations are often presented as making implanted neurotechnologies more appealing to patients. However, it remains unclear whether these innovations meaningfully impact patients' decision-making about adoption. The present study aims to examine how next-generation neurotechnology innovations shape prospective decision-making about adoption among patients with treatment-refractory depression (TRD), a key projected target population for these neurotechnologies.Approach. We identified nine aspects of next-generation neurotechnology innovation by reviewing public-facing materials from leading implanted neurotechnology companies. We then conducted interviews with 27 participants with TRD as well as six participants who currently have a deep brain stimulation implant for depression to assess their familiarity with and perceptions of neurotechnology, as well as their perspectives on next-generation innovations in implanted neurotechnologies for depression.Main results. While participants reported only moderate familiarity with implanted neurotechnology, most were willing to consider it as a treatment option if their depression was sufficiently severe. We identified four aspects of innovation that strongly impacted participants' decision-making about adoption: flexible therapy delivery, implant approach, internal footprint, and brain penetration. The remaining aspects (length of implant procedure, contact with brain, external visibility, device size and depth in skull) were seen as secondary considerations rather than decision-driving factors.Significance. Aspects of device design and therapy design that represent substantial patient burden or major intrusions into the body were most impactful for patients' prospective decisions about implanted neurotechnologies. Meanwhile, other aspects that are often emphasized by the industry-such as cosmetic invisibility and length of the implant procedure-were given less weight by the interviewed patients. These findings can help guide patient-centered priority-setting in device design in the TRD context.