EEG biomarker informed prescription of antidepressants in MDD: a feasibility trial

Eur Neuropsychopharmacol. 2021 Mar:44:14-22. doi: 10.1016/j.euroneuro.2020.12.005. Epub 2021 Jan 25.


Using pre-treatment biomarkers to guide patients to the preferred antidepressant medication treatment could be a promising approach to enhance its current modest response and remission rates. This open-label prospective study assessed the feasibility of using such pre-treatment biomarkers, by using previously identified EEG features (paroxysmal activity; alpha peak frequency; frontal alpha asymmetry) to inform the clinician in selecting among three different antidepressants (ADs; escitalopram, sertraline, venlafaxine) as compared to Treatment As Usual (TAU). EEG data were obtained from 195 outpatients with major depressive disorder prior to eight weeks of AD treatment. Primary outcome measure was the percentage change between before and after treatment on the Beck Depression Inventory-II (BDI-II). We compared TAU and EEG-informed prescription through AN(C)OVAs. Recruitment started with patients receiving TAU to establish baseline effectiveness, after which we recruited patients receiving EEG-informed prescription. 108 patients received EEG-informed prescription and 87 patients received TAU. Clinicians and patients were satisfied with the protocol. Overall, 70 (65%) of the EEG-informed clinicians followed recommendations (compared to 52 (60%) following prescriptions in the TAU group), establishing feasibility. We here confirm that treatment allocation informed by EEG variables previously reported in correlational studies, was feasible.

Keywords: Antidepressive agents; Biomarkers; Depressive disorder, Major; Electroencephalography; Feasibility studies.

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Biomarkers
  • Depressive Disorder, Major* / diagnosis
  • Depressive Disorder, Major* / drug therapy
  • Electroencephalography
  • Escitalopram
  • Feasibility Studies
  • Humans
  • Prescriptions
  • Prospective Studies
  • Treatment Outcome


  • Antidepressive Agents
  • Biomarkers
  • Escitalopram