Objective: Reducing unsuccessful treatment trials could improve depression treatment. Quantitative analysis of the electro-encephalogram (QEEG) might predict treatment response, and is being commercially marketed for this purpose. The authors sought to (1) quantify the reliability of QEEG for response prediction in depressive illness and (2) identify methodological limitations of the available evidence. Method: The authors performed a meta-analysis of diagnostic accuracy for QEEG in depressive illness, based on articles published between January 2000 and November 2017. The review included all articles that used QEEG to predict response during a major depressive episode, regardless of patient population, treatment, or QEEG marker. The primary meta-analytic outcome was the accuracy for predicting response to depression treatment, expressed as sensitivity, specificity, and the logarithm of the diagnostic odds ratio (DOR). Raters also judged each article on indicators of good research practice. Results: In 76 articles reporting 81 biomarkers, the meta-analytic estimates showed sensitivity 0.72 (0.67–0.76), specificity 0.68 (0.63–0.73), log(DOR) 1.89 (1.56–2.21), and area under the receiver-operator curve 0.76 (0.71–0.80). No specific QEEG biomarker or specific treatment showed greater predictive power than the all-studies estimate in a meta-regression. Funnel plot analysis suggested substantial publication bias (arcsine asymmetry test, t=6.33, p=2.64e-8). Most studies did not use ideal practices. Conclusions: QEEG does not appear clinically reliable for predicting depression treatment response due to under-reporting of negative results, a lack of out-of-sample validation, and insufficient direct replication of prior findings. Until these limitations are remedied, QEEG is not recommended for guiding psychiatric treatment selection.

BackgroundThis study explores the association of demographic and clinical features with quality of life and functioning in individuals with bipolar disorder.MethodsAdult participants (N = 482) with bipolar I or II disorder were enrolled in a comparative effectiveness study across eleven study sites and completed baseline measures of medical and psychiatric history, current mood, quality of life, and functioning. Participants with at least mildly depressive or manic/hypomanic symptomatic severity were randomized to receive lithium or quetiapine in addition to adjunctive personalized treatment for 6 months.ResultsParticipants with more severe depressive and irritability symptoms had lower quality of life and higher functional impairment. All psychiatric comorbid conditions except substance use disorder were associated with worse quality of life. On average, females had lower quality of life than males. Patients who were married, living as married, divorced, or separated had worse functional impairment compared with patients who were single or never married. A composite score of social disadvantage was associated with worse functioning and marginally associated with worse quality of life. Symptom severity did not moderate the effect of social disadvantage on quality of life or functioning.ConclusionsOur findings highlight that depression, irritability, and psychiatric comorbid conditions negatively impact quality of life and functioning in bipolar disorder. The study suggests that individuals with social disadvantage are at risk for functional impairment. Trial Registration This study is registered with ClinicalTrials.gov. Identification number: NCT01331304

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