Resting-state EEG activity in depression: a systematic review and meta-analysis

Depression is a highly prevalent and disabling disorder affecting approximately 5% of the adult population worldwide. Despite its impact, the underlying pathophysiology remains insufficiently understood, and current treatments are only partially effective. Understanding electrophysiological correlates of depression offers promise for a better grasp of the underlying brain mechanisms and might even guide novel treatment approaches, including neuromodulation. EEG is particularly attractive for this purpose due to its wide availability, cost-effectiveness, and potential for direct neuromodulatory targeting. We conducted a PROSPERO-registered systematic review in accordance with PRISMA guidelines to assess resting-state EEG activity in adult patients with depression, diagnosed according to DSM-IV/V or ICD-10/11. Included studies reported cross-sectional or correlational data on well-established quantitative EEG measures such as power, cordance, peak frequency, and alpha asymmetry. Semiquantitative analyses using modified albatross plots and meta-analyses were performed. Study quality was assessed with a modified Newcastle-Ottawa Scale. Fifty-two studies met the inclusion criteria. Semiquantitative findings showed a trend for increased low-frequency (delta and theta) and high-frequency (beta and gamma) power, as well as left frontal alpha asymmetry, in depressed patients compared to healthy controls. However, meta-analysis only confirmed a significant increase in beta power. Results regarding disease severity correlations and data on peak alpha frequency and cordance were insufficient for interpretation. Risk of bias across studies was high. Our results support a potential role for increased beta oscillations in depression. These oscillations may reflect disrupted corticolimbic control and reward processing and partially overlap with mechanisms implicated in chronic pain and fatigue. Further investigation is warranted into their potential as a diagnostic tool or even a biomarker, as well as their potential use as a neuromodulatory treatment target.