Effectiveness of fMRI-based Neurofeedback Therapy on Depression: A Systematic Review.

Objective: This systematic review explores the efficacy of fMRI-based neurofeedback as an alternative treatment for individuals with depression who do not respond well to traditional therapies. Methods: A comprehensive literature search across several databases (PubMed, Web of Science, ProQuest, Cochrane Library, and Google Scholar) identified 649 articles related to neurofeedback and depression, ultimately including 26 studies after eligibility assessments. Results: The majority of these studies, comprising both open-label and randomized controlled trials, reported significant reductions in depressive symptoms following neurofeedback interventions, which primarily targeted amygdala activity. Eighteen studies showed moderate to large effect sizes (Cohen's d values from 0.38 to 1.50) on validated depression measures. Notably, neurobiological changes were observed, including increased Blood Oxygenation Level Dependent (BOLD) activity and connectivity in emotion regulation regions such as the amygdala and prefrontal cortex. Some studies indicated sustained symptom improvements, with over 75% of patients applying learned strategies in daily life. However, methodological limitations and a moderate to high risk of bias were noted in several studies. Conclusion: fMRI-based neurofeedback presents a promising adjunctive therapy for depression, especially for patients who are resistant to standard treatments. Although current evidence shows positive effects on neural function and clinical outcomes, addressing methodological issues and standardizing study designs is essential. Future research should emphasize larger sample sizes and long-term efficacy while enhancing accessibility and cost-effectiveness in diverse clinical environments.