Measuring the efficacy of treatment with neurofeedback method in patients with affective disorders

Depression affects approximately 280 million people globally, with about 5% of adults experiencing an episode each year, making it a major public health concern. The high prevalence of treatment-resistant depression and the limitations of standard therapies highlight an urgent need for alternative treatments, such as neurofeedback, which has shown promising results in improving depressive symptoms when used alongside conventional pharmacological approaches. Aim of the study: To assess the efficacy of combining neurofeedback training with standard antidepressant therapy in adult patients with affective disorders. Materials and methods: This prospective, randomized study was conducted at the University Clinic for Psychiatry in Skopje, in a 2 month period. It involved a total of 100 outpatients diagnosed with affective disorders (ICD-10 codes F32, F33, F34). Participants were randomized into two groups: the study group (SG) that received both neurofeedback and antidepressant therapy, and the control group (CG) that received antidepressant monotherapy. The HAM-D and HAM-A scales, alongside with a structured psychiatric interview and sociodemographic questionnaire at baseline, were used to assess depressive and anxiety symptoms at baseline, 2 weeks, and 1 month. Data were analyzed with SPSS v23.0, using parametric and non-parametric tests, with significance set at p<0.05. The study received ethics approval, and all participants provided informed consent. Results: At baseline, both groups showed similar levels of depression and anxiety symptoms, with comparable average scores on the HAM-D (SG: 17.98 ± 5.7, CG: 18.42 ± 6.1) and HAMA (SG: 17.98 ± 6.8, CG: 21.36 ± 8.3) scales. At the two-week follow-up, the study group (SG) exhibited significant reductions in both HAM-D and HAMA scores compared to the control group (CG), with a decrease of 2.42 points in HAM-D (or 13.46% vs 0.65%) (p<0.0001) and 2.86 points in HAMA (13.72%, p<0.0001) for the SG, while the CG showed minimal change by 3.78%. At one-month follow-up, the SG continued to demonstrate marked improvement, with HAM-D scores at 14.50 ± 5.5 versus 17.56 ± 6.2 in the CG (p=0.0064) and HAMA scores at 16.82 ± 6.7 in the SG compared to 20.14 ± 8.3 in the CG. Conclusion: The results from the study suggest that neurofeedback, when combined with medication, may enhance both early and sustained symptom improvement of depression and anxiety.