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Current Status of QEEG and Neurofeedback in the Treatment of Clinical Depression
By: Jonathan Walker, MD, Robert Lawson, MS

Depression is an almost universal experience. Fortunately, it usually remits spontaneously after a period of time. Unfortunately, it does not spontaneously remit in many individuals, and they are diagnosed as being 'clinically" depressed, requiring treatment to be able to have an acceptable quality of life and be able to work. Several depression subtypes have been defined based on their semiology (Table I). We have indicated the most common abnormalities found in our clinic for each type of depression, and indicated the type of neurofeedback training that most effectively remediates the depression and prevents further episodes, in our experience. Note that alpha asymmetry appears in most cases to be a state marker rather than a trait marker, and is not seen with the linked ears reference used in all commercially available databases. One must use a CZ reference to identify the asymmetry and Cz is not an inactive reference. However, alpha asymmetry may represent a trait marker in some patients, and alpha asymmetry training may produce long-lasting remissions in some patients.

The Neurobiology of Depression
Adolphs and Tranel (2004) reviewed the neurobiology of emotions generally and in depression and mania, specifically. Neural structures that process emotions in humans include the left and right hemispheres, amygdala, orbitofrontal cortex, basal ganglia, cingulated gyrus and hippocampus. The left cerebral hemisphere is more involved in positive emotions, and the right hemisphere is more involved in negative emotions. Davidson and Irwin (1999) posited an approach/withdrawal dimension, correlating increased right hemisphere activation with increases in withdrawal behavior (including emotions such as fear or sadness, as well as depressive tendencies), and increased left hemisphere activity with increase in approach behaviors (including emotions such as happiness). An important key issue for neurofeedback therapists is what exactly constitutes "activation." We will address this in the QEEG section of this chapter. Major depression has been associated with damage to the frontal lobes, especially the left frontal pole (Starkstein & Robinson, 1991). PET studies have shown that a region under the genu of the corpus callosum, the subcallosal gyrus, is consistently underactivated in patients with depression (Ongur, Drevets, & Price, 1998). As reviewed by Liotti and Mayberg (2001) depression also is associated with hypometabolism in the cingulate cortex and occasionally in other areas such as the orbitofrontal, insular, and anterior temporal cortices, amygdalae, basal ganglia, and thalamus.
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