The Efficacy of Neurofeedback in Patients with Major Depressive Disorder: An Open Labeled Prospective Study
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The purpose of this study was to evaluate the effect of neurofeedback on depressive symptoms and electrophysiological disturbances in patients with major depressive disorder. We recruited participants suffering from depression to evaluate efficacy of left prefrontal beta with alpha/theta training. An 8-week, prospective, open-label study was undertaken. Twenty participants were recruited. The treatment protocol was twice or three times a week training of beta at F3 with alpha/theta at Pz for 8 weeks. When every visit, patients were received beta training for 30 min, and then alpha/theta training for 30 min. Baseline, 4 and 8 week scores of; the Hamilton rating scale for Depression (HAM-D), the Hamilton rating scale for Anxiety (HAM-A), the Beck Depression Inventory (BDI)-II, the Beck Anxiety Inventory (BAI), Clinical global impression-severity (CGI-S), and pre- and post-treatment resting state EEGs were compared. Interhemispheric alpha power asymmetry (A score) was computed for homologous sites F3–F4. Pre- and post-training clinical assessments revealed significant improvements in HAM–D, HAM-A, BDI, and CGI-S scores. Cumulative response rates by HAM-D were 35.0 and 75.0 % at 4 and 8 weeks, respectively, corresponding cumulative remission rates by HAM-D were 15.0 and 55.0 %, respectively. No significant differences were found between pre- and post-treatment A score. Neurofeedback treatment could improve depressive symptoms significantly. In addition, anxiety symptoms and clinical illness severity decreased significantly after neurofeedback treatment. Despite its several limitations, such as, small sample size and lack of a control group, this study suggested neurofeedback has significant effects in patients with major depressive disorder.
KeywordsNeurofeedback Beta training Depression Asymmetry score
This work was supported by a Yeungnam University Research Grant (2012). We deeply appreciate to our colleagues, Dai-Seg Bai Ph.D., Hye-Guem Kim M.D., Young-Ji Lee M.D., Seung-Woo Lee, M.D., Jae-Hwa Choi M.D., Su-Hong Ha M.A. for helping in this study.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- American Psychiatric Association. (2000). Diagnostic criteria from DSM-IV-TR. Washington, D.C.: American Psychiatric Association.Google Scholar
- Baehr, E., & Baehr, R. (1997). The use of neurofeedback as adjunctive therapeutic treatment for depression: Three case studies. Biofeedback, 25, 10–11.Google Scholar
- Baxter, L. R. Jr., Schwartz, J. M., Phelps, M. E., Mazziotta, J. C., Guze, B. H., Selin, C. E., et al. (1989). Reduction of prefrontal cortex glucose metabolism common to three types of depression. Archives of General Psychiatry, 46(3), 243–250.Google Scholar
- Beck, A. T., & Steer, R. A. (1990). Beck anxiety inventory manual. San Antonio, TX: Psychological Corporation.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for beck depression inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
- Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 28–37.Google Scholar
- Davidson, R. J., & Henriques, J. B. (2000). Regional brain function in sadness and depression. In J. Borod (Ed.), The neuropsychology of emotion (pp. 269–297). New York: Oxford University Press.Google Scholar
- Kato, T., Shioiri, T., Murashita, J., Hamakawa, H., Takahashi, Y., Inubushi, T., et al. (1995). Lateralized abnormality of high energy phosphate metabolism in the frontal lobes of patients with bipolar disorder detected by phase-encoded 31P-MRS. Psychological Medicine, 25, 557–566.CrossRefPubMedGoogle Scholar
- Kung, S., Alarcon, R. D., Williams, M. D., Poppe, K. A., Jo Moore, M., & Frye, M. A. (2013). Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice. Journal of Affective Disorder, 145(3), 341–343. doi: 10.1016/j.jad.2012.08.017.CrossRefGoogle Scholar
- Murthy, V. N., & Fetz, E. E. (1992). Coherent 25- to 35-Hz oscillations in the sensorimotor cortex of awake behaving monkeys. Proceedings of the National Academy of Sciences of the United States of America, 89(12), 5670−5674.Google Scholar
- Rosenfeld, J. P. (1997). EEG biofeedback of frontal alpha asymmetry in affective disorders. Biofeedback, 25(1), 8–25.Google Scholar
- Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., et al. (2003). The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDSSR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54, 573–583.CrossRefPubMedGoogle Scholar
- Rush, A. J., Trivedi, M. H., Stewart, J. W., Nierenberg, A. A., Fava, M., Kurian, B. T., & Wisniewski, S. R. (2011). Combining medications to enhance depression outcomes (CO-MED): Acute and long-term outcomes of a single-blind randomized study. The American Journal of Psychiatry, 168(7), 689–701. doi: 10.1176/appi.ajp.2011.10111645.CrossRefPubMedGoogle Scholar
- United States, Depression Guideline Panel, & United States, Agency for Health Care Policy and Research. (1993). Depression in primary care. Rockville, Md. Washington, D.C: U.S. Dept. of Health and Human Services.Google Scholar
- Zimmerman, M., Chelminski, I., & Posternak, M. (2004). A review of studies of the Hamilton depression rating scale in healthy controls: Implications for the definition of remission in treatment studies of depression. The Journal of Nervous and Mental Disease, 192(9), 595–601.CrossRefPubMedGoogle Scholar