BACK TO ARTICLES

Depression and Bipolar Disorder

Thinking Man on Couch

Baehr, E., Miller, E., Rosenfeld, J. P., & Baehr, R. (2004). Changes in frontal brain asymmetry associated with premenstrual dysphoric disorder: A single case study. Journal of Neurotherapy , 8(1), 29-42.

Background. In a pilot study, Baehr (2001) reports changes in frontal cortical alpha asymmetry during the luteal phase of the menstrual cycle were documented in five depressed women who also experienced Premenstrual Dysphoric Disorder (PMDD). In this paper detailed data is presented for one of these subjects and two comparison subjects who were part of the first study.

The goal was two-fold: (a) to study how patterns of mood changes during the lutealphase of the menstrual cycle correlated with  changes in frontal alpha brainwave asymmetry, and (b) to determine whether treatment strategies, tailored to ameliorate symptoms, would be reflected in brainwave changes.

Method. Neurofeedback, medical interventions, and prospective charting were collected over a period of six months for one patient. These data were compared with data collected for two monthly cycles from two non-PMDD comparison subjects. Results . The patient responded well to the neurofeedback protocol for depression and was normalizing her scores by the second week in treatment except for setbacks which occurred during the luteal phase of her menstrual cycle. Extreme mood changes correlated with changes in brainwave asymmetry during this period. A combination of neurofeedback and medication worked to stabilize her mood swings and asymmetry scores.

 

Conclusion. This case study demonstrated how brainwave changes in frontal alpha asymmetry occurred during the luteal phase of the menstrual cycle in a woman who suffered from PMDD. Two comparison subjects, who were undergoing similar treatment for depression but did not suffer from PMDD, had stable alpha asymmetry scores during the entire menstrual cycle. Anomalies in serotonergic and/or gabergic function in the luteal phases of PMDD are pinpointed as possible underlying factors in this disorder.

 

Baehr, E., Rosenfeld, J. P., & Baehr, R. (1997). The clinical use of an alpha asymmetry protocol in the neurofeedback treatment of depression: Two case studies. Journal of Neurotherapy , 2(3), 10-23. In this study we are presenting case studies of two depressed women who were trained with more than 34 sessions each of EEG biofeedback (neurofeedback) using an Alpha Asymmetry protocol, the purpose of this training was to determine if depression could be alleviated when the subjects learned to increase the activation of the left hemisphere and/ or decrease the activation of the right hemisphere. The MMPI-2 was administered before and after training to measure changes in personality factors, including depression. The results suggest that Alpha Asymmetry neurofeedback training may be an effective adjunct to psychotherapy in the treatment of certain types of mood disorders.

 

Baehr, E., Rosenfeld, J. P., & Baehr, R. (2001). Clinical use of an alpha asymmetry neurofeedback protocol in the treatment of mood disorders: Follow up study one to five years post therapy. Journal of Neurotherapy , 4(4), 11-18.

Background: This study reports on three of six patients who have completed an average of 27 neurofeedback sessions using a patented alpha asymmetry protocol for the treatment of depression. Method: The follow-up data, from one to five years post therapy, were derived from a single session re-test using the same alpha asymmetry protocol and the Beck Depression Inventory.

 

Results: The three patients originally diagnosed as having unipolar depression reached the training criteria for the nondepressed range by the end of their initial training, and they have maintained their normal scores for right hemisphere alpha asymmetry training over time. The follow -up Beck Depression Inventory scores were also within the normal range.

Discussion: This finding is contrary to the previously held demonstrations by Davidson and Henriques regarding the stability of decreased left anterior cortical activation in remitted depression. While some patients have reported mood changes with life's vicissitudes, none have. experienced clinical depression since they have terminated therapy.

 

Escalano, C., Navarro-Gil, M., Garcia-Campayo, J & Minguez, J. (2013). EEG-based upper-alpha neurofeedback for cognitive enhancement in major depressive disorder: a preliminary, uncontrolled study. Conference Proceedings: IEEE 2103:6293-6. Conditioning of the upper-alpha rhythm to improve cognitive performance in healthy users by means of neurofeedback (NF) has been evaluated by several studies, however its effectiveness in people with severe cognitive deficits, such as depressive subjects, remains underexplored. This paper reports on a preliminary uncontrolled study to assess the effects of an upper-alpha NF intervention on patients with major depressive disorder (MDD). The NF effects on the EEG and cognitive performance were assessed. The EEG results showed that patients were able to modulate the upper-alpha rhythm in task-related EEG and during training, in both cases across the executions of the NF sessions, and pre and post within each session. The behavioral results showed the effectiveness of this intervention in a variety of cognitive functions such as working memory, attention, and executive functions.

 

Hammond, D. C. (2001). Neurofeedback treatment of depression with the Roshi. Journal of Neurotherapy , 4(2), 45-56.

Introduction. A patient with severe, medication resistant depression was found to have the frontal alpha asymmetry described in Davidson's (1998a) research as demonstrating a predisposition to depression.

Treatment. Initial sessions of EEG neurofeedback using Rosenfeld's (1997) protocol for correcting the alpha asymmetry were discouraging, actually producing slight negative change. Therefore, treatment shifted to using the Roshi, a two channel unit combining neurofeedback and photic stimulation, doing primarily left hemisphere beta training.

Results.The very first Roshi session produced positive changes, and within five sessions the patient reported feeling less depressed and more energetic. At the conclusion of thirty training sessions, objective testing documented dramatic reductions in depression, somatic symptoms, overemotionality, anxiety, rumination, and fatigue.

Discussion. In support of Henriques and Davidson's (1991) belief that hypoactivation of the left hemisphere results in an “approach deficit” and more withdrawal behavior, posttesting and interview data also documented that the patient had become less withdrawn, more active, sociable, and less distrustful. Eight and one-half month follow-up documented maintenance of changes. Continued exploration of left hemisphere beta protocols in

treating depression, and of the combined use of neurofeedback with photic stimulation are encouraged.

 

Hardman, E., Gruzelier, J., Chessman, K., Jones, C., Liddiard, D., Schleichert, H., & Birbaumer, N. (1997). Frontal interhemispheric asymmetry: Self  regulation and individual differences in humans. Neuroscience Letters, 221, 117-120.

Sixteen subjects naive to biofeedback learned lateralised interhemispheric control of slow cortical potentials (SCPs) across electrode sites F3-F4 during three sessions of visual electroencephalograph (EEG) biofeedback. Subjects were required to generate slow negativity shifts either towards the left or the right hemisphere in sixty pseudoran domly ordered trials per session. Group 1 (n = 8) were told to use emotional strategies in the task (positive emotions for left hemisphere activation, negative emotion for right hemisphere activation), group 2 received no guidance. Both groups received feedback in the form of an on-screen rocket-ship, initially centrally placed, which rose to indicate an increase in left hemisphere negativity (relative to the right hemisphere) and fell to indicate an increase in right hemisphere negativity (relative to the left hemisphere). A 2 x 3 x 3 x 2 ANOVA

(group x session x block x trial) showed no performance differences between the strategy and no strategy groups. Both groups learned to produce correct direction shifts in the final third of each session during both trial types (P < 0.001). The no strategy group showed a particularly strong within session learning effect (P < 0.0037) with poor performance in the early part of the sessions, and strong shifts at the end. Subjects high on withdrawal showed stronger rightward shifts in keeping with right hemisphere involvement in behavioural withdrawal. This is the first demonstration of self regulation of interhemispheric frontal asymmetry.

Kumano, H., Horie, H., Shidara, T., Kuboki, T. et al. (1996). Treatment of a depressive disorder patient with EEG-driven photic stimulation. Biofeedback & Self-Regulation, 21(4), 323-334. This study examined the effects of electroencephalographic-(EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.

Kumano, H., Horie, H., Shidara, T., Kuboki, T. et al. (1996). Treatment of a depressive disorder patient with EEG-driven photic stimulation. Biofeedback & Self-Regulation, 21(4), 323-334.

This study examined the effects of electroencephalographic-(EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance. However, the consensus among the attending medical personnel was that the improvements noted above took place with unusual expeditiousness. Discussion. When performing EEG biofeedback it may be most practical to adopt an “exercise model” approach in which the regulatory mechanisms in the brain are challenged through the sequential use of multiple protocol configurations. In this case several different training protocols proved useful in her ongoing recovery. While improvements in functioning were

a result of a concerted effort involving multiple therapeutic interventions, it is likely that neurofeedback played a vital synergistic role.

Raymond, J., Varney, C., Parkinson, L. A., & Gruzelier, J. H. (2005). The effects of alpha/theta neurofeedback on personality and mood. Cognitive Brain Research, 23, 287-292.

Alpha/theta neurofeedback has been shown to be successful both in treating addictions and in enhancing artistry in music students. How its effects are mediated are not yet clear. The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalising extreme personality and raising feelings of well-being. 12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change in either group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056). Real feedback caused participants to feel significantly more energetic (P < 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P < 0.01), agreeable (P < 0.01), elevated (P < 0.01) and confident (P < 0.05), whilst sessions of mock feedback made participants feel more tired (P < 0.05), yet composed (P < 0.01). These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.