Amital Daniela, Gross Raz, Goldental Nadav, Fruchter Eyal, Yaron-Wachtel Haya, Tendler Aron, Stern Yaki, Deutsch Lisa, Voigt Jeffrey D, Hendler Talma, Harmelech Tal, Singer Neomi, Sharon Haggai
Barzilai Medical Center, Ashkelon 7830604, Israel.
Sheba Medical Center, Ramat Gan 52621, Israel.
Brain Sci. 2025 Apr 29;15(5):476. doi: 10.3390/brainsci15050476.
Up to 75% of patients with major depressive disorder (MDD) exhibit persistent anhedonia symptoms related to abnormalities in the positive valence system. Cumulative evidence points to brain dysfunction in the reward system (RS), including in the ventral striatum, in patients with MDD with anhedonia. This study aims to evaluate the safety and efficacy of a novel neurofeedback (NF) device (termed Prism) which incorporates the EEG-FRI-Pattern biomarker of the reward system (RS-EFP) for use in self-neuromodulation training (RS-EFP-NF) for alleviating depression in patients with MDD with anhedonia. A total of 49 adults (age range: M = 39.9 ± 11.03) with a DSM-5 diagnosis of MDD with anhedonia (per a SHAPS-C score ≥ 25) were screened for the administration of ten sessions of RS-EFP-NF twice a week on nonconsecutive days. Depression and anhedonia severity was assessed, respectively, by HDRS-17 and SHAPS-C at baseline, midway, and treatment end. A total of 34 patients (77%) completed the protocol and were included in the analyses. No device-related adverse events were serious or required treatment. Depression symptoms were reduced at end of treatment as indicated by the HDRS-17, with a reduction of eight points on average (95% CI: -10.5 to -5.41, < 0.0001), a clinical improvement rate of 78.47%, and a remission rate of 32.25%. Anhedonia, as indicated by the SHAPS-C score, was diminished, showing an average reduction of 6.3 points (95% CI: -8.51 to -4.14, < 0.0001). Self-neuromodulation using RS-EFP-NF is a promising and safe treatment for MDD with anhedonia. The intervention demonstrates substantial clinical effects on both depression and anhedonia symptoms, with high patient acceptability and retention. Prism may address a critical mechanism-driven treatment gap for anhedonia that often persists despite conventional therapies. Larger controlled implementation, efficacy, and dosing studies are warranted.
高达75%的重度抑郁症（MDD）患者表现出与正性效价系统异常相关的持续性快感缺失症状。越来越多的证据表明，伴有快感缺失的MDD患者的奖赏系统（RS）存在脑功能障碍，包括腹侧纹状体。本研究旨在评估一种新型神经反馈（NF）设备（称为Prism）的安全性和有效性，该设备结合了奖赏系统的脑电图-功能相关成像模式生物标志物（RS-EFP），用于自我神经调节训练（RS-EFP-NF），以缓解伴有快感缺失的MDD患者的抑郁症状。总共筛选了49名成年人（年龄范围：M = 39.9 ± 11.03），他们符合DSM-5中伴有快感缺失的MDD诊断标准（根据SHAPS-C评分≥25），在非连续日每周进行两次RS-EFP-NF治疗，共十次。在基线、中期和治疗结束时，分别通过HDRS-17和SHAPS-C评估抑郁和快感缺失的严重程度。共有34名患者（77%）完成了方案并纳入分析。没有与设备相关的严重不良事件或需要治疗的事件。治疗结束时，HDRS-17显示抑郁症状减轻，平均降低了8分（95%CI：-10.5至-5.41，<0.0001），临床改善率为78.47%，缓解率为32.25%。SHAPS-C评分显示快感缺失减轻，平均降低了6.3分（95%CI：-8.51至-4.14，<0.0001）。使用RS-EFP-NF进行自我神经调节是一种有前景且安全的治疗伴有快感缺失的MDD的方法。该干预措施对抑郁和快感缺失症状均显示出显著的临床效果，患者接受度和依从性高。Prism可能解决了尽管有传统疗法但常常持续存在的快感缺失的关键机制驱动的治疗缺口。有必要进行更大规模的对照实施、疗效和剂量研究。
