34 The future role of fmri neurofeedback in depression treatment and research

Objectives/Aims FMRI-neurofeedback for major depressive disorder (MDD) is of great interest to clinicians and neuroscientists. Here, the aim was to review the current clinical trials evidence. Methods We undertook a systematic literature search of fMRI-neurofeedback trials in MDD, including our unpublished results. Results fMRI-neurofeedback was effective in current MDD when reinforcing brain responses to positive pictures,1 but was not superior to a control neurofeedback intervention in a recent randomised controlled trial2 (RCT). Another RCT showed that reinforcing amygdala responses to positive autobiographical memories3 was superior versus a control neurofeedback intervention4. We have developed neurofeedback of self-blame-selective functional connectivity between right superior anterior temporal (AT) and subgenual frontal regions. In remitted MDD, we demonstrated that self-esteem can be increased using this approach in a double-blind RCT. In a recently completed RCT in early treatment-resistant MDD, the majority of patients responded to guilt-related AT-subgenual connectivity neurofeedback. Surprisingly, a self-guided matched psychological intervention tackling self-blame without neurofeedback showed comparable levels of response. Secondary analyses, however, showed that neurofeedback was superior for those patients without anxious distress features. Conclusions This calls for longer-term studies to reproduce previous results and stratified trials to combine psychological and neurofeedback interventions. As a research tool, neurofeedback uncovers causal relationships between functions and anatomical subdivisions. References D. E. Linden, et al., PloS one 2012;7:e38115. D. M. A. Mehler, et al., Neuropsychopharmacology, (2018). K. D. Young, et al., PloS one 2014;9:e88785. K. D. Young, et al., Am. J. Psychiatry 2017;174:748–755.