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According to Trambaiolli et al., major depressive disorder (MDD) is "the leading cause of disability worldwide." As such, psychologists, psychiatrists, neuroscientists, and other field-related specialists are constantly looking for novel treatments that could improve patient outcomes.

In recent years, the potential benefits of neurofeedback for depression have taken the spotlight. Neurofeedback's mechanism of action has undoubtedly intrigued specialists. More precisely, it has prompted them to study its potential to balance brain wave activity to reduce negative thoughts and improve cognitive function in people with depression.

As such, does neurofeedback really work for depression? In this article, we will discuss what depression is, how neurofeedback works, and whether it is a good complementary therapy for depression.

Key Takeaways

• Neurofeedback is a non-invasive therapy that utilizes real-time monitoring of brain activity to teach self-regulation, promoting improved mental health and mood stability.

• Neurofeedback therapy targets different brain regions linked to depression. Its goal is to balance brain activity in those particular areas. This can potentially reduce negative emotions, improve emotion regulation skills, as well as enhance cognitive functions.

• Studies have shown that neurofeedback therapy can lead to significant long-term depressive symptom improvement, although future research is required to fully confirm the benefits of neurofeedback for depression.

• People who want to try neurofeedback to manage depressive symptoms should only do so at a clinic, under the supervision of a qualified professional.

What Is Depression?

According to the World Health Organization, depression "involves a depressed mood or a loss of pleasure or interest in activities for long periods of time." Depression can affect all aspects of life and cause problems at home, at work, or in academic settings.

Statistics show that approximately 3.8% of the total global population experience depression - this translates into approximately 280 million people. Statistics also show that it is 50% more common in women than in men and predominantly more common in pregnant women and those who have just given birth.

Some of the most common symptoms of a depressive episode include:

• A depressed mood

• Sadness and irritability

• A feeling of emptiness

• Poor concentration

• Hopelessness

• Excessive guilt or low self-esteem

• Poor sleep

• Physical symptoms like changes in appetite and weight

• Low energy

• Forgetfulness

It must be distinguished from regular mood changes that are normal once in a while, and this can be done based on symptom duration. The symptoms of a depressive episode occur every day (the entire day) for at least two weeks, and the episode can be mild, moderate, or severe, depending on the symptoms.

How Is Depression Treated?

Depression can be addressed with psychological treatment and antidepressant medication, which are usually only recommended for moderate and severe depression episodes.

Psychological treatment may include:

• Cognitive Behavioral Therapy (CBT)

• Behavioral activation

• Problem-solving therapy

• Interpersonal psychotherapy

These treatments are aimed at breaking negative thought patterns and teaching the patient new coping mechanisms.

Another integral part of managing depression symptoms is self-care. This includes anything that can promote overall well-being and make one feel better - from doing activities they enjoy and staying connected with family and friends to avoiding alcohol consumption and seeking professional help.

Now that we've covered the basics of depression, let's see what neurofeedback is and whether it can help.

What Is Neurofeedback?

Neurofeedback, a specialized form of biofeedback, focuses on measuring and analyzing brain activity. Let's turn for a second to biofeedback, which is crucial for our understanding of how neurofeedback works. Biofeedback is a non-invasive approach that enhances our sense of self-awareness in terms of bodily functions. The primary goal of biofeedback therapy is to empower individuals to consciously influence various physiological responses - in other words, it's a sophisticated type of self-regulation and mindfulness.

As such, within the broader field of biofeedback, neurofeedback targets brain function specifically. It aims at retraining the brain's responses to various stimuli. The process is rooted in the principles of neuroplasticity, which is the brain's ability to change, adapt, and create new neural pathways. Another principle is operant conditioning - a learning mechanism through which people modify their behavior depending on associated reinforcement or punishment.

But how exactly does neurofeedback work? Most commonly, it is done through electroencephalography (EEG), which implies placing electrodes on a person's scalp to measure brain wave activity. Brain waves are basically electrical impulses in our brains. Why do they matter? Because there are different types of brain waves, and each is associated with a different state. For example, gamma waves are associated with high cognitive function. On the other hand, delta waves are associated with deep relaxation and are common when we're sleeping.

But there's another important thing we haven't covered yet. Neurofeedback doesn't only imply measuring brain wave activity through EEG - there's also the feedback part, which is the most important. Let's see how it works.

EEG Neurofeedback Sessions

During an EEG neurofeedback session, the patient is asked to perform a cognitive activity - watch a movie or play a video game. And let's say that person's goal is to improve focus. In this case, the neurofeedback protocol is adjusted to focus on increasing specific brain wave activity.

As such, when the person is watching a video, for example, and is focused on that activity, they will be able to continue watching the video without interruptions. When they lose their focus, they receive immediate visual or auditory feedback - the screen darkens, or the video stops, for instance. When they regain their focus, the screen lights up. Naturally, the type of activity and the way feedback is delivered are different for each clinic, so this is just an example.

Through this process, people can increase their self-awareness about their responses to stimuli. Over time, this self-awareness enables them to identify what helps them relax, focus, and feel better overall, at the same time receiving insights into what causes them to be stressed, agitated, or anxious. This process teaches people how to manipulate, so to speak, their behaviors to achieve desired states.

Neurofeedback brain training can also be done via other technologies besides EEG. Functional near-infrared spectroscopy (fNIRS) and functional magnetic resonance imaging (fMRI), for example, have a different approach. They measure blood flow and oxygenation in specific brain parts. This technology is just as effective as EEG, except that it simply measures a different type of brain activity. Nonetheless, fNIRS and fMRI aren't commonly used in clinics because they're highly advanced and, therefore, expensive.

Can Neurofeedback Help with Depression?

Although it is a relatively recent therapeutic approach, having been first demonstrated in the 1960s, neurofeedback has already gained recognition for its potential to help people with depression. We'll go into more detail about scientific evidence below, but first, let's see how exactly neurofeedback can help with depression. In this regard, three aspects are of utmost importance:

• Neurofeedback sessions targeting depression should only be done at a clinic under the supervision of a qualified neurofeedback therapy specialist. At-home neurofeedback devices are not medical devices and should not be used to manage depression or any other medical condition without the supervision of a therapist. That being said, your therapist may recommend using a consumer-grade device if it can help with your depression symptoms.

• Neurofeedback sessions targeting depression are usually performed under a personalized treatment protocol elaborated based on the patient's brain map (qEEG). The treatment protocol should be adjusted based on the patient's progress or any side effects.

• Neurofeedback sessions targeting depression should only serve as a complementary approach alongside other treatments like Cognitive Behavioral Therapy (CBT).

The Benefits of Neurofeedback for Depression

As such, how exactly can neurofeedback help with depression? Here are some potential benefits:

• It can help regulate brain activity. For example, research shows that left frontal beta training and alpha waves/theta waves training could reduce depressive symptoms. The treatment protocol may also focus on the left prefrontal cortex, which shows signs of weakness in people with depression. However, the targeted brain waves and regions are personalized following a brain map, although the goal is the same - to balance brain wave activity so that the patient experiences fewer negative thoughts and emotions.

• It can help reduce anxiety symptoms, given that it often co-occurs with depression. For instance, some patients with anxiety have an excess of rapid brain waves, and the treatment protocol may be adjusted to balance them.

• It can help improve sleep patterns, emotion regulation skills, stress management skills, as well as focus and concentration, which can contribute to an increased sense of self-worth.

• It can potentially lead to long-lasting results, with some studies showing that the benefits of neurofeedback can last for 6-12 months.

How Many Neurofeedback Sessions Are Needed for Depression?

On average, people with depression require approximately 20-40 sessions of neurofeedback to show significant improvements and long-lasting results. Some people feel the benefits only after 10-20 sessions, while others need a longer period.

Nonetheless, this timeframe highly depends on the patient's symptoms and their severity, as well as on what other treatments they undergo. Additionally, this timeframe depends on the neurofeedback specialist's experience and ability to adjust the treatment protocol as needed based on the patient's progress.

What Does Evidence Say About Neurofeedback as Treatment for Depression?Now that we've explained how exactly neurofeedback can help with depression, let's see whether there's any scientific evidence supporting these claims. Below, we'll present the results of several important studies highlighting the benefits of neurofeedback for depression:

• 24 adult patients with treatment-resistant depression (TRD) participated in a study aiming at demonstrating the effects of neurofeedback. 12 of the patients with TRD were assigned to the medication-only group, while the other 12 received 12-24 neurofeedback sessions over 12 weeks. The patients who received neurofeedback treatment showed reduced mean scores of 50%-58.3% in several depression rating scales, while the patients in the medication-only group showed less significant changes.

• A systematic review analyzing 12 studies showed that EEG neurofeedback may be an effective supplementary treatment for depression.

• A more recent study published in 2023 focused on the effects of fMRI neurofeedback on depression. The participants received fMRI neurofeedback focused on their amygdala and parietal responses. Afterward, they received 10 Cognitive Behavioral Therapy sessions. The results were compared to the results of the control group. The participants who received neurofeedback treatment and CBT sessions showed "decreased depressive symptomatology and higher remission rates at 6-month and 1-year follow-up than the control group." However, the authors state that the study was relatively small and insufficient to fully illustrate potential benefits.

• Another systematic review analyzing 24 studies showed that neurofeedback training with both EEG and fMRI-based protocols can lead to significant improvements, as well as cognitive and neural changes. Nonetheless, the authors concluded that most of the studies have not completely followed best practice standards, which is why future research is recommended.

Therefore, although most studies conclude that neurofeedback can be a powerful complementary therapy to reduce depressive symptoms, most of them also show that further research is still required to fully confirm this application. This only reinforces the fact that neurofeedback for depression should only be performed by a qualified professional, and it should only serve as a complementary therapy.

Can At-Home Neurofeedback Help with Depression?

Neurofeedback devices designed for at-home use should not be used by people with depression because they are not medical devices.

In certain situations, a therapist might recommend a consumer-grade neurofeedback device for at-home use either as an alternative to in-clinic sessions or as a way to maintain progress after completing in-clinic training.

Ultimately, at-home neurofeedback devices are only designed for wellness purposes to improve cognitive function, stress resilience, and overall well-being. If this is your goal, you can try the Mendi device, which uses cutting-edge fNIRS technology to train your prefrontal cortex, which is at the forefront of your executive function and other cognitive abilities.

Frequently Asked Questions

What is neurofeedback, and how does it work?

Neurofeedback is a non-invasive biofeedback technique that measures and helps regulate brain activity, allowing individuals to develop healthier brain patterns. By providing real-time feedback, it promotes improved mental health and cognitive functioning.

How does neurofeedback target depression specifically?

Neurofeedback specifically targets dysregulated brain areas associated with depression, which can potentially reduce negative thoughts, improve mood, and enhance a person's self-regulating abilities.

What are the benefits of neurofeedback for depression?

Neurofeedback therapy can help people with depression by enhancing emotion regulation abilities, improving sleep and motivation, and offering a non-invasive, drug-free complementary treatment option. This approach can also address co-occurring anxiety and boost cognitive function.

How effective is neurofeedback in treating depression?

Neurofeedback has been shown to significantly reduce depressive symptoms, offering lasting benefits as a complementary treatment for depression. However, future research is required for a more comprehensive picture of neurofeedback's efficacy for depression.

What should I expect when starting neurofeedback therapy?

You can expect an initial consultation to assess your needs and possibly a brain map, followed by a tailored treatment protocol and regular progress reviews to ensure optimal results.