Effects of neurofeedback on major depressive disorder: a systematic review

Dobbins, Isabelly Cristine de Souza; Bastos, Murilo; Ratis, Renan Cassiano; Silva, Weber Claúdio Francisco Nunes da; Bonini, Juliana Sartori

doi:10.31744/einstein_journal/2023RW0253

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • einstein (São Paulo) 21 • 2023 • https://doi.org/10.31744/einstein_journal/2023RW0253 copy

Effects of neurofeedback on major depressive disorder: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated.

Objective

We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies.

Methods

We searched for experimental studies published between 1962–2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria.

Results

We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results.

Conclusion

Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Depressive disorder, major; Brain waves; Neurofeedback

Study	NF type	Methodology	Depression scales	Total number of sessions	Results
Mehler et al.(⁴4. Mehler DM, Sokunbi MO, Habes I, Barawi K, Subramanian L, Range M, et al. Targeting the affective brain-a randomized controlled trial of real-time fMRI neurofeedback in patients with depression. Neuropsychopharmacology. 2018;43(13):2578-85.)	fMRI-NF	Any mental strategy NFE: imagery of positive stimuli NFS: imagery of scenes	HDRS, HADS	5	Significant improvement up to 25% upregulation of emotion areas and 50% upregulation of a control region activated by visual scenes
Tsuchiyagaito et al.(⁵5. Tsuchiyagaito A, Smith JL, El-Sabbagh N, Zotev V, Misaki M, Al Zoubi O, et al. Real-time fMRI neurofeedback amygdala training may influence kynurenine pathway metabolism in major depressive disorder. Neuroimage Clin. 2021;29:102559.)	rtfMRI-NF	Upregulated LA activity with kynurenine measured using two task block regressors, “happy” and “count”	MADRS	2	Thirteen participants exhibited a ≥25% reduction in the MADRS score
Cheon et al.(⁶6. Cheon EJ, Koo BH, Choi JH. The Efficacy of Neurofeedback in Patients with Major Depressive Disorder: an Open Labeled Prospective Study. Appl Psychophysiol Biofeedback. 2016;41(1):103-10.)	Asymmetry rotocol	Training of the left hemisphere with beta waves at F3 and with alpha/theta waves at Pz	HAM-D, HAM-A, BDI-II, BAI	16 to 24	Significant improvement in HAM-D scores
Chen et al.(⁷7. Chen TC, Lin IM. The learning effects and curves during high beta down-training neurofeedback for patients with major depressive disorder. J Affect Disord. 2020;266:235-42.)	Asymmetry protocol	Training with delta, theta, alpha, and low and high beta waves at P3 and P4	BDI-II, BAI	10	Significant improvement of cognitive depression but not somatic depression
Wang et al.(¹⁴14. Wang SY, Lin IM, Peper E, Chen YT, Tang TC, Yeh YC, et al. The efficacy of neurofeedback among patients with major depressive disorder: preliminary study. NeuroRegulation. 2016;3(3):127–34.)	Asymmetry protocol	ALAY protocol, down-training of the alpha power at F3, and up-training of alpha power at F4	BDI-II, BAI	6	57.14% of the subjects did not respond to the intervention
Choi et al.(¹⁵15. Choi SW, Chi SE, Chung SY, Kim JW, Ahn CY, Kim HT. Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study. Neuropsychobiology. 2011;63(1):43-51.)	Asymmetry protocol	EEG from F3 and F4 in a trial with classical music where the participants had to keep the sound on and try to raise its volume	HAM-D, BDI-II	50% of the participants with depression showed significant improvement	50% of the participants with depression showed significant improvement
Zotev et al.(¹⁶16. Zotev V, Yuan H, Misaki M, Phillips R, Young KD, Feldner MT, et al. Correlation between amygdala BOLD activity and frontal EEG asymmetry during real-time fMRI neurofeedback training in patients with depression. Neuroimage Clin. 2016;11:224-38.)	rtfMRI-EEG-NF	Real-time display screen for happy memories, with task runs and simultaneously frontal EEG in the upper alpha band	HDRS, HARS, MADRS, SHAPS, HAS, TAS, POMS, STAI, VAS	2	Significant improvement by VAS, POMS, HDRS, and SHAPS
Zotev et al.(¹⁷17. Zotev V, Bodurka J. Effects of simultaneous real-time fMRI and EEG neurofeedback in major depressive disorder evaluated with brain electromagnetic tomography. Neuroimage Clin. 2020;28:102459.)	rtfMRI-EEG-NF	Real-time GUI display screen for happy memories with task runs alpha and high-beta EEG for F3 and F4	MADRS, POMS, STAI, SHAPS	Differences between the control and experimental groups did not reach significance	The control and experimental group were not significantly different
Takamura et al.(¹⁸18. Takamura M, Okamoto Y, Shibasaki C, Yoshino A, Okada G, Ichikawa N, et al. Antidepressive effect of left dorsolateral prefrontal cortex neurofeedback in patients with major depressive disorder: a preliminary report. J Affect Disord. 2020;271:224-7.)	rtfMRI-NF	A run of rest block (gray) and up-regulation block (green) that the participants had to raise the signal in the green as compared to the gray signal, target ROI	BDI-II, HDRS, RRQ	5	Significant improvement by RRQ
Young et al.(¹⁹19. Young KD, Zotev V, Phillips R, Misaki M, Yuan H, Drevets WC, et al. Real-time FMRI neurofeedback training of a mygdala activity in patients with major depressive disorder. PloS One. 2014;9(2):e88785.)	rtfMRI-NF	Real-time display screen to recall happy autobiographical memories with task runs, target ROI	MADRS, POMS, VAS, STAI	1	Significant improvement in the scales related to mood effects
Young et al.(²⁰20. Young KD, Siegle GJ, Zotev V, Phillips R, Misaki M, Yuan H, et al. Randomized clinical trial of real-time fmri amygdala neurofeedback for major depressive disorder: effects on symptoms and autobiographical memory recall. Am J Psychiatry. 2017;174(8):748-55.)	rtfMRI-NF	Patients had to retrieve positive memories while attempting to increase the hemodynamic activity in the assigned region. With task runs.	MADRS, BDI-II, SHAPS, HAM-D, HAM-A, BDI-II, SHPS	2	The responder groups exhibited significant improvement
Schneider et al.(²¹21. Schneider F, Heimann H, Mattes R, Lutzenberger W, Birbaumer N. Self-regulation of slow cortical potentials in psychiatric patients: depression. Biofeedback Self Regul. 1992;17(3):203-14.)	SCP-NF	Trial of visual feedback of SCP where the assignment of trial type (negative or positive slow potential) was discriminated by the stimuli	HAM-D, GAS, BPRS	20	Minimal correlation with depression scales
Liu(²²22. Liu H. Neurofeedback training intervention for persons with major depression disorder: Reducing depressive symptoms. NeuroQuantology. 2017;15(3):179–84.)	Asymmetry protocol	Alpha-beta protocol (suppress alpha wave and amplified beta wave) of the left hemisphere at F3 and two other electrodes on the eardrum	BDI-II	9	No significant improvement

Study	Eligibility criteria	Subjects randomly allocated	Concealed allocation	Groups similar at baseline	Blinding of subjects	Blinding of therapists	Blinding of assessors	<15% dropout	intention to treat analysis if necessary	between-group statistical comparisons	Point estimate and variability	Total
Mehler et al.(⁴4. Mehler DM, Sokunbi MO, Habes I, Barawi K, Subramanian L, Range M, et al. Targeting the affective brain-a randomized controlled trial of real-time fMRI neurofeedback in patients with depression. Neuropsychopharmacology. 2018;43(13):2578-85.)	Yes	Yes	No	Yes	No	Yes	Yes	No	No	Yes	Yes	2/10
Tsuchiyagaito et al.(⁵5. Tsuchiyagaito A, Smith JL, El-Sabbagh N, Zotev V, Misaki M, Al Zoubi O, et al. Real-time fMRI neurofeedback amygdala training may influence kynurenine pathway metabolism in major depressive disorder. Neuroimage Clin. 2021;29:102559.)	Yes	No	No	No	No	No	No	Yes	Yes	Yes	No	3/10
Cheon et al.(⁶6. Cheon EJ, Koo BH, Choi JH. The Efficacy of Neurofeedback in Patients with Major Depressive Disorder: an Open Labeled Prospective Study. Appl Psychophysiol Biofeedback. 2016;41(1):103-10.)	Yes	No	No	No	No	No	No	Yes	Yes	No	Yes	3/10
Chen et al.(⁷7. Chen TC, Lin IM. The learning effects and curves during high beta down-training neurofeedback for patients with major depressive disorder. J Affect Disord. 2020;266:235-42.)	Yes	No	No	Yes	No	No	No	Yes	Yes	Yes	Yes	5/10
Wang et al.(¹⁴14. Wang SY, Lin IM, Peper E, Chen YT, Tang TC, Yeh YC, et al. The efficacy of neurofeedback among patients with major depressive disorder: preliminary study. NeuroRegulation. 2016;3(3):127–34.)	No	Yes	No	No	No	No	No	No	No	Yes	Yes	6/10
Choi et al.(¹⁵15. Choi SW, Chi SE, Chung SY, Kim JW, Ahn CY, Kim HT. Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study. Neuropsychobiology. 2011;63(1):43-51.)	No	No	No	No	No	No	No	Yes	Yes	Yes	Yes	6/10
Zotev et al.(¹⁶16. Zotev V, Yuan H, Misaki M, Phillips R, Young KD, Feldner MT, et al. Correlation between amygdala BOLD activity and frontal EEG asymmetry during real-time fMRI neurofeedback training in patients with depression. Neuroimage Clin. 2016;11:224-38.)	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	5/10
Zotev et al.(¹⁷17. Zotev V, Bodurka J. Effects of simultaneous real-time fMRI and EEG neurofeedback in major depressive disorder evaluated with brain electromagnetic tomography. Neuroimage Clin. 2020;28:102459.)	Yes	No	No	No	No	No	No	No	No	Yes	No	5/10
Takamura et al.(¹⁸18. Takamura M, Okamoto Y, Shibasaki C, Yoshino A, Okada G, Ichikawa N, et al. Antidepressive effect of left dorsolateral prefrontal cortex neurofeedback in patients with major depressive disorder: a preliminary report. J Affect Disord. 2020;271:224-7.)	Yes	No	No	No	No	No	No	Yes	No	Yes	Yes	2/10
Young et al.(¹⁹19. Young KD, Zotev V, Phillips R, Misaki M, Yuan H, Drevets WC, et al. Real-time FMRI neurofeedback training of a mygdala activity in patients with major depressive disorder. PloS One. 2014;9(2):e88785.)	Yes	No	No	No	No	No	No	Yes	Yes	No	No	3/10
Young et al.(²⁰20. Young KD, Siegle GJ, Zotev V, Phillips R, Misaki M, Yuan H, et al. Randomized clinical trial of real-time fmri amygdala neurofeedback for major depressive disorder: effects on symptoms and autobiographical memory recall. Am J Psychiatry. 2017;174(8):748-55.)	No	No	No	Yes	No	No	No	Yes	Yes	Yes	Yes	9/10
Schneider et al.(²¹21. Schneider F, Heimann H, Mattes R, Lutzenberger W, Birbaumer N. Self-regulation of slow cortical potentials in psychiatric patients: depression. Biofeedback Self Regul. 1992;17(3):203-14.)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	no	Yes	Yes	4/10
Liu(²²22. Liu H. Neurofeedback training intervention for persons with major depression disorder: Reducing depressive symptoms. NeuroQuantology. 2017;15(3):179–84.)	No	No	No	Yes	No	No	No	Yes	Yes	Yes	Yes	3/10

Instituto Israelita de Ensino e Pesquisa Albert Einstein Avenida Albert Einstein, 627/701 , 05651-901 São Paulo - SP, Tel.: (55 11) 2151 0904 - São Paulo - SP - Brazil
E-mail: revista@einstein.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Isabelly Cristine de Souza Dobbins Pharmaceutical Sciences Sector Rua Padre Salvatore Renna, 875 Zip code: 85015-430, Guarapuava, PR, Brazil Phone (55 42) 9 9975-9523 E-mail: isabellydobbins@gmail.com