Electroencephalogram alpha asymmetry in patients with depressive disorders: current perspectives

Figures & data

Table 1 Comparison of methods in studies on EEG AA

No	Study	Sample		Age (years)		% female	Classification of depressive status	Method	EEG detail
		Experimental group	CG	Experimental group	CG				Reference montage	EO/EC	Recording length (min)	Alpha range (Hz)
1	Liu et al^Citation57	EG: N = 141 (38 melancholic MDD and 103 non-melancholic MDD)	CG: 113 non-MDD patients	EG1 – melancholic: M = 35.92 (SD = 12.86) and EG2 – non-melancholic: M = 32.79 (SD = 11.66)	CG: M = 32.56 (SD = 12.50)	66.50	SCID, HRS	Group comparison	LMas	EO + EC	6 × 1	7.8–12.7
2	Cantisani et al^Citation66	EG: 20 patients with a diagnosis of MDD	CG: 19 healthy adults	EG: M = 43.3 (SD = 14.03)	CG: M = 41.05 (SD = 13.82)	53.80	SCID, HAMD, MADRS, BDI	Group comparison and correlation	CA	EO + EC	6	8–12.5
3	Arns et al^Citation73	EG: 1,008 MDD patients	CG: 336 healthy controls	EG: M = 37.84 (SD = 12.6)	CG: M = 36.99 (SD = 13.1)	57	MINI-Plus, HRSD	Group comparison	LMas	EO + EC	2 × 2	8–13
4	Stewart et al^Citation71	EG: 143 MDD	CG: 163 healthy controls	M = 19.1 (SD = 0.1)	Range: 17–34	69.00	SCID, BDI	Group comparison	CA, Cz, LMas, CSD	EO + EC	8 × 1	8–13
5	Manna et al^Citation82	EG1: 14 high- anxiety depressive and EG2: 14 low-anxiety depressive	CG: 21 healthy controls	EG1: M = 39.9 (SD = 11.7) and EG2: M = 31.4 (SD = 11.7)	CG: M = 34.0 (SD = 11.8)	57.10	BDI	Group comparison	LMas	EO		8–13
6	Escolano et al^Citation74	74 MDD patients were randomly allocated to the NF group (n = 50) or to the CG (n = 24)	CG: 24 MDD patients randomly selected	NF group: M = 53.70 (SD = 10.87)	CG: M = 49.50 (SD = 10.18)	68.30	BDI-II, PHQ-9	Group comparison	FPz, l ear	EO + EC	6	8–12
7	Spronk et al, 2008^Citation76	8 patients with MDD		M = 42.6 (range 28–50)		37.50	BDI, MINI-Plus		LMas	EO + EC	4	8–13; alpha 1 (8–11) and alpha 2 (11–13)
8	Mathersul et al^Citation54	428 subjects selected from the Brain Resource International Database		M = 34.85 (SD = 12.59), range 18–60		50	DASS-21	Group comparison	CA	EC	2	8–13
9	Pössel et al, 2008^Citation77	80 mentally healthy adolescents		M = 13.92 (SD = 0.57), range: 13–15		43.75	DSQ, DISYPS-KJ: SBB-DE	Regression analyses	Nose	EO + EC	4 × 2	8–13
10	Tops et al^Citation79	11 healthy male volunteers		M = 27.7, range: 19–42		0	BDI	Group comparison	l ear/LE	EO + EC	2	8–13
11	Metzger et al^Citation75	50 female Vietnam War nurse veterans		M = 53.7 (SD = 2.8)		100	SCID, SCL-90-R	Correlation	LE	EO + EC	2 × 3	8–13
12	Kentgen et al^Citation80	EG: 25 outpatients (19 MDD [11 MDD + current anxiety disorder] and 6 anxiety disorders)	CG: 10 non-ill controls	M = 15.5, range: 12.2–18.8		100	PARIS, K-SADS, DISC-2.3-C	Group comparison	Nose	EO + EC	2 × 3	7.8–12.5
13	Graae et al^Citation65	EG: 16 Hispanic females after suicide attempt	CG: 22 normal Hispanic adolescent girls	M = 14, range: 12–17		100	BDI, HASS	Group comparison	Nose, C3 & C4	EO + EC	2 × 3	8–13
14	Adolph and Margraf^Citation59	43 healthy students showing symptoms of depression or anxiety		Range: 19–34		65.12	D-S	Regression analyses	l-Mas	EO + EC	8	8–13
15	Cantisani et al^Citation66	EG: 20 MDD patients	CG: 19 healthy controls	EG: M = 43.3 (SD = 14.03)	CG: M = 41.05 (SD = 13.82)	53.80	SCID, HAMD, MADRS, BDI	Group comparison and correlation	Cz	EC	6	Lower alpha: 8–10 and upper alpha: 10.5–12.5
16	Moynihan et al^Citation67	EG: 105 MBSR group	CG: 103	EG: M = 73.3 (SD = 6.7)	CG: M = 73.6 (SD = 6.7)	59.60	CES-D-R	Group comparison	r-Mas	EO + EC	8 × 1	8–13
17	Bruder et al^Citation81	EG: high-risk group (37)	CG: low-risk group (38)	EG: M = 33.9 (SD = 11.7)	CG: M = 27.4 (SD = 13.5)	53.33	SADS-L, K-SADS-E, K-SADS-PL	Group comparison and correlation	l ear	EO + EC	4 × 2	7.0–12.5
18	Keune et al^Citation68	N = 57 recurrently depressed women in remission EG: mindfulness support group 25	CG: rumination challenge group (32)	EG: M = 43.56 (SD = 9.67)	CG: M = 49.09 (SD = 10.82)	100	BDI-II, PANAS	Group comparison and correlation	LMas	EO + EC	8 × 1 and 10	8–13
19	Segrave et al^Citation85	EG: 16 MDD	CG: 18 controls	EG: M = 40.75 (SD = 11.39)	CG: M = 42.11 (SD = 13.02)	100	BDI, MINI-Plus, MADRS	Group comparison	Cz, CA	EO + EC	2 × 3	8–13 and IAF
20	Chan et al^Citation55	Participants with depression, EG1: 17 CBT and EG2: 17 DMBI	Participants with depression, CG: WL	EG1: M = 46.94 (SD = 6.54) and EG2: M = 47.06 (SD = 9.54)	CG: M = 45.44 (SD = 8.25)	80	SCID	Group comparison and correlation	LE	EC	5	8–13
21	Gordon et al^Citation60	EG: 567 participants across 6 clinical groups	CG: 1,908 healthy control participants from the BRID	Range: 6–87		45.80	MINI	Group comparison	LMas	EO + EC	2 × 2	8–13
22	Kemp et al^Citation51	EG: 14 patients with PTSD and 15 patients with MDD	CG: 15 healthy controls	EG – PTSD: M = 41.4 (SD = 12.3) and MDD: M = 39.9 (SD = 14.0)	CG: M = 42.4 (SD = 16.7)	61.40	MINI, HRSD, DASS	Group comparison	LMas	EC	2	8–13
23	Beaton et al^Citation63	Undergraduate students, EG: 24 high socially anxious	Undergraduate students, CG: 25 low socially anxious	M = 20.32 (SD = 4.18)		75.50	DASS-21	Group comparison and correlation	Cz	EC + EO	2	8–13
24	De Raedt et al^Citation64	20 volunteer students				85	BDI-II	Regression analyses	Cz	EC	2	8–12
25	Bruder et al^Citation84	EG1: 19 highest risk group and EG2: 14 intermediate risk group	CG: 16 lowest risk group	EG1: M = 15.4 (SD = 4.7) and EG2: M = 10.6 (SD = 4.5)	CG: M = 13.6 (SD = 6.2)	53	SADS-L, K-SADS-E, K-SADS-PL	Group comparison	LE	EO + EC	4 × 2	7.0–12.5
26	McFarland et al^Citation70	70 participants		M = 34.64 (SD = 12.97), range: 18–63		65.70	SCID	Correlation	LE	EO + EC	6 × 1	8–13
27	Diego et al^Citation52	Woman (effects of maternal depression), EG: 20 undefined (CES-D = 0–2); 10 borderline (CES-D = 13–15), 69 depressed (CES-D >16)	CG: 64 non- depressed (CES-D = 3–12)	M = 23 (SD = 5.0)		100	CES-D	Group comparison and correlation	Cz		3	8–12
28	Bruder et al^Citation4	EG: 44 depressed outpatients	CG: 26 normal patients	EG: anxious group: M = 36.7 (SD = 11.5); Nonanxious: M = 41.3 (SD = 10.7)	CG: M = 32.9 (SD = 9.8)	50	BDI	Group comparison and correlation	Nose	EO + EC	2 × 3	7.8–12.5
29	Tomarken et al^Citation53	EG: 25 high-risk patients	CG: 13 low-risk patients	EG: M = 13.1 (SD = 0.3)	CG: M = 13.0 (SD = 0.4)	52.60	SCID, K-SADS-E, CDI, K-LIFE	Group comparison and regression analyses	Cz	EO + EC	8 × 1	8.5–12.5
30	Jesulola et al^Citation20	100 participants		32.5 (SD = 14.13)		54	SDS	Group comparison and correlation	CA	EO + EC	3 × 3	8–13
31	Kaiser et al^Citation17	39 females: EG1: anxiety + depression; EG2: depression participants	CG: healthy participants	EG1: M = 78.6 (SD = 6.7) and EG2: M = 80.5 (SD = 5.7)	CG: M = 80.9 (SD = 7.0)	100	HADS-A, HADS-D, GDS	Group comparison and correlation	r-Mas	EC + EO	3	Alpha 1 (6.9–8.9), alpha 2 (8.9–10.9), and alpha 3 (10.9–12.9)
32	Brzezicka et al^Citation83	EG: 26 depressed patients	CG: 26 controls	M = 26.42 (SD = 6.5)			ICD-10 classification criteria	Group comparison and correlation	CSD	EC	5	8–13
33	Mennella et al^Citation35	EG: 23 dysphoric individuals	CG: 24 nondysphoric individuals	EG: M = 21.0 (SD = 1.6)	CG: M = 15.9 (SD = 4.4)	100	BDI-II, SCID	Group comparison	l-Mas	EO	5	8–13
34	Quinn et al^Citation58	EG: 117 MDD patients (57 with melancholia and 60 with non- melancholia)	CG: 120 healthy controls				MINI-Plus	Group comparison	LMas, CA	EC	2	8–13
35	Gold et al^Citation8	79 adults		M = 35.6 (SD = 9.8), range: 18–50		78.5	MADRS, HADS-A	Correlations	EC	EC	5	8–12
36	Allen and Cohen^Citation56	306 young adults – 143 with MDD		M = 19.1 (SE = 0.1), range: 17–34		69	BDI	Group comparison and correlation	Cz, CSD	EC + EO	8	8–13
37	Saletu et al^Citation61	EG: 60 female depressed menopausal syndrome patients	CG: 30 normal controls	EG: M = 51.10 (SD = 3.13)		100	DSM-IIIR	Group comparison (SPM)		EC	7	8–10
38	Carvalho et al^Citation16	EG1: 12 depressed patients and EG2: 8 remitted patients	CG: 7 non-depressed patients	M = 71.3		66.60	DSM-IV	Group comparison	l ear	EC	8	8–12.9
39	Deslandes et al^Citation15	EG: 22 depressed elderly participants	CG: 14 healthy elderly participants	EG: M = 71.6 (SD = 1.2)	CG: M = 72.4 (SD = 1.7)	94.40	DSM-IV	Group comparison	LE	EC	8	8–13
40	Putnam and McSweeney^Citation62	EG: 6 depressed outpatient groups	CG: 7 healthy CG	EG: M = 32.6 (SD = 12.1)	CG: M = 32.8 (SD = 11.3)	69.20	BDI	Group comparison	Cz	EC + EO	4 × 4	8–13
41	Barnhofer et al^Citation69	22 individuals with a previous history of suicidal depression were randomly assigned to either MBCT (n = 10) or treatment-as-usual group (n = 12)	CG: 12 treatment-as-usual group	EG: M = 48.0 (SD = 10.2)	CG: M = 38.6 (SD = 9.6)	50	BDI	Group comparison	CA, LE	EC + EO	8	8–13
42	Bruder et al^Citation47	EG1: 18 subjects were both parents and had an MDD and EG2: 40 subjects were one parent and had an MDD	CG: 29 subjects were neither parent and had an MDD	EG1: M = 29.0 (SD = 11.0), range: 8–47 and EG2: M = 37.0 (SD = 8.0), range: 22–50	CG: M = 37.1 (SD = 4.7), range: 29–47	60.90	SADS-L, K-SADS-E, K-SADS-PL	Group comparison	l ear	EC	4 × 2	7.0–12.5
43	Allen et al^Citation14	30 women		range: 18–45		100	SCID	Group comparison and correlation	Cz, LMas	EO + EC	8	8–13
44	Debener et al^Citation72	EG: 15 clinically depressed patients	CG: 22 healthy adults	EG: M = 48.5, range: 23–64	CG: M = 45.9, range: 26–64	67.6	Structural clinical interview ICD-10	Group comparison	LE	EO + EC	2	8–13

Abbreviations: AA, alpha asymmetry; BDI, Beck Depression Inventory; BRID, Brain Resource International Database; C3 and C4, average between central left and right; CA, common average; CBT, cognitive behavioral therapy; CG, control group; CES-D-R, depression scale-revised; CSD, current source density transformation; Cz, the midline central position; DASS, depression anxiety stress scales; DISC-2.3-C, Diagnostic Interview Schedule for Children; DISYPS-KJ: SBB-DE, self-rating questionnaire for depressive disorders measures symptom criteria in accordance with DSM-IV diagnoses of depressive disorders; DSQ, depressions-screening questionnaire; DMBI, Chan-based Dejian mind-body intervention; DSM-IIIR, Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EC, eyes closed; EEG, electroencephalogram; EG, experimental group; EO, eyes open; FPz, frontal-midline electrode; GDS, geriatric depression scale; HADS-A, hospital anxiety and depression scale; HADS-D, hospital anxiety and depression scale – German version; HAMD, Hamilton depression rating scale; HASS, Harkavy, Asnis Suicide scale; HRS, Hamilton rating scale; HRSD, Hamilton rating scale for depression; K-SADS, schedule for affective disorders and schizophrenia; K-SADS-PL, Kiddie-sads-present and lifetime version; LE, left ear; LMas, left-mastoid; M, median; MADRS, Montgomery–Åsberg Depression Rating Scale; MBCT, Mindfulness-based cognitive therapy; MBSR, mindfulness-based stress reduction; MINI-Plus, mini-international neuropsychiatric interview; MDD, major depressive disorder; NF, neurofeedback; PANAS, positive and negative affect scales; PARIS, Parent as Respondent Informant Schedule; PHQ-9, Patient Health Questionnaire; PTSD, posttraumatic stress disorder; SE, standard error; SADS-L, schedule for affective disorders and schizophrenia lifetime version for adults and for children between the ages 6 and 17, the child version (K-SADS-E); SCID, structured clinical interview for DSM-IV; SCL-90-R, symptom checklist revised; SPM, statistical parametric maps; WL, waitlist control group.

Table 2 Controlling for common known confounders

Study	Controlled for
	Handedness controlled	Handedness inquired	Education reported	Medication reported	Medication controlled	Comorbidity reported	Comorbidity controlled
Debener et al^Citation72	x		x	x			x
Manna et al^Citation82	x		x			x
Carvalho et al^Citation16	x			x		x
Segrave et al^Citation85	x			x			x
Deslandes et al^Citation15	x			x			x
Allen and Cohen^Citation56	x				x		x
Allen et al^Citation14	x				x		x
Tomarken et al^Citation53	x				x
Graae et al^Citation65	x					x
Stewart et al^Citation71	x						x
Cantisani et al^Citation66	x		x	x		x
Cantisani et al^Citation66	x		x	x		x
Bruder et al^Citation4	x		x		x	x
Kemp et al^Citation51	x			x		x
Pössel et al^Citation77	x					x
Kaiser et al^Citation17		x	x	x
Putnam and McSweeney^Citation62		x	x		x		x
McFarland et al^Citation70		x	x			x
Bruder et al^Citation84		x		x		x
Barnhofer et al^Citation69		x		x			x
Kentgen et al^Citation80		x			x	x
Menella et al^Citation78		x			x	x
Quinn et al^Citation58		x			x	x
Adolph and Margraf^Citation59		x			x		x
Beaton et al^Citation63		x			x		x
Liu et al^Citation57		x				x
Keune et al^Citation68		x				x
Gold et al^Citation8		x				x
Bruder et al^Citation47		x				x
Tops et al^Citation76		x					x
Brzezicka et al^Citation83		x
Metzger et al^Citation75		x	x		x	x
Mathersul et al^Citation54		x			x		x
Moynihan et al^Citation67			x	x		x
Chan et al^Citation55			x	x		x
Arns et al^Citation73			x		x	x
Diego et al^Citation52			x		x
Bruder et al^Citation81				x		x
Spronk et al^Citation76				x
Saletu et al^Citation61				x
Gordon et al^Citation60					x		x
Escolano et al^Citation74						x
De Raedt et al^Citation64
Jesulola et al^Citation20

Note: x indicates variable was controlled.

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