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2.2. Treatment of Depressive Disorders
The main methods of treatment of depressive disorders include pharmacological therapy and psychosocial interventions (psychoeducation and group and individual psychotherapy) . Biofeedback and TMS are less commonly used. In individuals with depression,relevant therapeutic targets include maladaptive thoughts and beliefs,lowered mood,quality of life,and others. Reducing the risk of suicide in severe depression is also an important therapeutic goal.
2.2.1. Pharmacological Therapy
The most common medication used for treating depression is serotonin reuptake inhibitors (e.g.,sertraline and paroxetine),tricyclic antidepressants (citalopram and fluoxetine),and monoamine oxidase inhibitors (moclobemide and pirlindole). The mechanism of action of antidepressants is based on a change in the concentration of neurotransmitters available for binding in the brain,which leads to long-term potentiation or depression of synaptic connections . The choice of medication is made based on their safety and the observed therapeutic effect in a particular patient. Doses are adjusted by the medical professional during treatment. Antipsychotics can also be used in depressive states that have arisen as part of psychotic disorders (e.g.,bipolar disorder) . Pharmacological therapy is usually only required for moderate to severe depressive disorders. The combination of pharmacological therapy and psychotherapy is optimal for the treatment of such forms of depression .
2.2.2. Psychosocial Interventions
The main psychosocial intervention for working with patients with mild depression is psychoeducation,providing information about the symptoms and the possible progression of the disorder,recommendations for self-help,and lifestyle changes (if necessary). Other suitable psychosocial interventions for patients with depressive disorders are group and individual psychotherapy. The most studied approaches for the treatment of depression are cognitive behavioral therapy and its variations,psychodynamic therapy,schema therapy,and decision-oriented therapy . In general,psychotherapeutic approaches do not differ significantly in effectiveness,so the choice of a particular approach in each case depends on the availability of a specialist and the individual preferences of the patient. Besides psychotherapy,regular physical exercise could also be considered a part of a psychosocial intervention. Regular exercise has been shown to be effective in reducing depressive symptoms . Positive changes may result from the metabolic and hormonal changes that accompany regular exercise.
2.2.3. Biofeedback
Biofeedback methods have also been shown to be effective in reducing depressive symptoms. A meta-analysis of 14 randomized controlled trials in 794 subjects showed significant improvements in symptoms in patients with depression . Neurofeedback using EEG and fMRI demonstrated promising results in reducing depressive symptoms,but the number of published studies is still limited .
2.2.4. Brain Stimulation
Studies demonstrated that transcranial magnetic stimulation had a potentiating effect on antidepressant intake and was associated with improved clinical outcomes . TMS is recommended by several national medical agencies for use in the treatment of depression as a procedure with potentially positive results and no side effects . However,there is currently insufficient data to draw definitive conclusions about the effectiveness of TMS in reducing depressive symptoms.
2.2.5. Application of Machine Learning
Machine learning is also used to assess the treatment effectiveness in depressive disorders . The effectiveness of depression treatment using antidepressants or TMS can be assessed by using and applying classical machine learning methods (support vector machine and random forest ) or deep neural network algorithms to EEG data .
The machine learning methods used and the accuracy achieved in predicting depression treatment based on EEG data are presented in [Table 4](https://ncbi.nlm.nih.gov/pmc/articles/PMC9914271/table/diagnostics-13-00573-t004/) .","department":"