Neurofeedback As a Treatment for Major Depressive Disorder – A Pilot Study

Frenk Peeters,Richel Lousberg,Jacco Ronner,Mare Oehlen,Jim van Os,Cornelis Jan Stam

doi:10.1371/journal.pone.0091837

Abstract

BackgroundThere is growing interest in neurofeedback as a treatment for major depressive disorder. Reduction of asymmetry of alpha-activity between left and right prefrontal areas with neurofeedback has been postulated as effective in earlier studies. Unfortunately, methodological shortcomings limit conclusions that can be drawn from these studies. In a pilot-study, we investigated the effectiveness of reduction of asymmetry of alpha-activity with neurofeedback in depressed participants with the use of a stringent methodological approach.MethodsNine participants meeting DSM-IV criteria for major depressive disorder were treated with a maximum of 30 neurofeedback-sessions, aimed at reducing asymmetry of alpha-activity, over a 10-week period. No changes in the use of antidepressants were allowed 6 weeks before and during the intervention. Changes in depressive symptomatology were assessed with the Quick Inventory of Depressive Symptoms, self-report version.ResultsWe observed response in 1 and remission in 4 out of a total of 9 participants. The effectiveness appeared largest in female participants. The mean asymmetry of alpha-activity decreased significantly over sessions in a quadratic fashion. This decrease was associated with clinical response.ConclusionsThis pilot study suggests that neurofeedback aimed at a reduction of frontal asymmetry of alpha-activity may be effective as a treatment for depression. However, this was an open label pilot study. Non-specific effects of the procedure and/or a beneficial natural course may have confounded the results. Randomized controlled trials will have to establish the efficacy of neurofeedback for depression.Trial RegistrationNederlands Trial Register NTR1629

Highlights

There is growing interest in neurofeedback (NF) as a treatment for a variety of mental disorders including ADHD, anxiety, and depression [1,2]
It should be underlined that increased alpha activity in cortical structures is indicative of decreased cortical activation in those areas
The optimal duration of NF-sessions is apparently shorter than the 8 minutes that we had chosen based on previous reports. This NF pilot study into the effectiveness of NF as a treatment for MDD showed response in 1 and remission in 4 out of a total of 9 participants. This clinical change is in line with those from previous reports showing that neurofeedback, aimed at reducing AA, may be associated with a reduction in depressive symptomatology [1,20,21,22,23]

Summary

Introduction

There is growing interest in neurofeedback (NF) as a treatment for a variety of mental disorders including ADHD, anxiety, and depression [1,2]. Major depressive disorder (MDD) appears to be associated with relatively more left than right resting (alpha, 8–13 Hz) activity in prefrontal regions [5,6,7,8], some inconclusive studies exist This difference in alpha activity between both prefrontal regions, has become known as alpha-asymmetry (AA) in MDD. In a pilot-study, we investigated the effectiveness of reduction of asymmetry of alpha-activity with neurofeedback in depressed participants with the use of a stringent methodological approach

Objectives

Methods

Results

Conclusion