Effects of swLORETA Z-score neurofeedback in Z-coherence of the fronto-limbic circuit in patients with major depressive disorder.

Patients with major depressive disorder (MDD) exhibit abnormal hypercoherence within the fronto-limbic circuit (FLC), involving core brain regions such as the ventrolateral, ventromedial, dorsolateral, dorsomedial prefrontal cortex (vlPFC, vmPFC, dlPFC, dmPFC), and the amygdala (AMY). This study examined the effects of standardized weighted low-resolution electromagnetic tomography Z-score neurofeedback (swLZNFB) on LFC coherence and emotional symptoms. Sixty-one MDD patients were assigned to either the swLZNFB or control groups. All participants completed the Beck Depression Inventory II (BDI-II), the Beck Anxiety Inventory (BAI), and a five-minute eyes-closed resting-state electroencephalography (EEG) assessment both at pre-test and post-test. EEG coherence values were processed and converted into Z-scores across five frequency bands (delta to high beta), using the NeuroGuide normalization database. Compared to the control group, the swLZNFB group exhibited significantly reduced theta and beta Z-coherence values between vlPFC-AMY and dmPFC-AMY at post-test. Within-group comparisons revealed significantly decreased in beta Z-coherence between vlPFC-AMY from pre-test to post-test. Moreover, the swLZNFB group demonstrated significant decreases in depression and anxiety symptoms, whereas the control group showed improvement in depression only. These findings suggest that swLZNFB effectively modulates FCL hyperconnectivity and alleviates emotional symptoms in MDD, supporting its potential as a non-pharmaceutical intervention targeting dysfunction emotion regulation networks.