New study explains how music affects the brains of patients with depression

Songs are known to modulate neuronal activity in subcortical brain structures, modifying our mood. For this reason, some experts believe that music could be a powerful tool to combat depression. The idea makes sense in theory, but it has shown limited effects in practice. Only a small proportion of patients suffering from depression show any response to musical stimuli. This is partly because it is not known how the power of music should be used: there is still little understanding of the neurological processes that are triggered when we listen to a song. But today, science is getting closer to reaching answers.

A study published on Friday in the journal Cell Reports analyzed the neurological reaction to music in 23 patients with treatment-resistant depression. The researchers examined how the brains of these patients reacted to musical stimuli, and discovered that the neuronal oscillations of the auditory cortex — which processes sensory information — synchronized with the neuronal oscillations of the reward circuitry — which processes emotional information. In other words, what the patients heard mimicked what they felt. According to the researchers, this phenomenon is the healing power of music acting on the human brain.

“This study reveals that music induces a triple temporal blocking of neuronal oscillations through auditory synchronization,” explains Bomin Sun, director of the Center for Functional Neurosurgery at Shanghai Jiao Tong University and lead author of the study, in an exchange of messages. The blocking and synchronization occurs in the circuit that runs from the stria terminalis to the nucleus accumbens. This brain structure, also called the extended amygdala, is related to unpleasant emotions and plays a prominent role in depression processes. “With this, we have tried to discover the mechanisms through which music influences these brain areas, providing a scientific basis for personalized music therapy for depression,” adds Tong.

“Their analysis is very interesting because it allows us to see how music can neuromodulate us and alleviate depressive symptoms,” says Jesús Romero Imbroda, head of Neurology at the Quirón Salud Hospital in Málaga, Spain, who did not participate in the study. While praising the study, Imbroda points out some of its limitations: “It is not a randomized trial, it involved only a few patients, and they are Asian, which has sociocultural implications that are difficult to transfer to the West…” But he believes this research — which closely aligns with previous scientific literature — helps to understand how our brain processes music and emotions. “It is one more brick in this wall of knowledge,” he explains in a telephone conversation.

One of the virtues of the experiment is that it provides a very specific building block. Bomin Sun’s team wanted to determine not only whether music in general can improve our mood, but what kind of music can do so. For example, to find out whether it is important for the patient to know the song in question and to like it, or whether the style of the song, more melancholic or more cheerful, can impact our mood differently.

To determine this, the patients were divided into two groups. One group, consisting of 13 participants, had never heard the songs before. The other group, consisting of 10 patients, listened to them repeatedly days before the experiment. They were then asked to rate the songs, according to their tastes. With this data in hand, some were given the songs they liked the most and others the ones they liked the least.

The songs were a mix of sad tunes, such as Tchaikovsky’s Symphony No. 6, and more cheerful ones, such as the third movement of Beethoven’s Seventh Symphony. But the emotional context of the songs did not affect the listeners’ mood. “The improvement in depressive symptoms was not linked to the emotion of the music itself, but to the patient’s level of musical enjoyment,” explains Sun. The subjective preference for a particular song did have a significant impact. In other words, what most determined whether a patient would be cheered up by song was not if it was a happy or sad song, but whether they liked it. “People have different levels of connection with music, which can significantly affect therapeutic outcomes,” the expert adds. “This highlights the importance of personalizing music therapy.”

The present study “provides a foundation for any research focused on the interaction between music and emotions,” says Sun. This is not an experiment with theoretical value; the authors hope that this evidence will have practical applications. “Ultimately, we want to translate our findings into clinical practice, developing effective and effective music therapy tools and applications.” That is the idea, but some have questioned it.

Musicology, a therapy under evaluation

Depression is on the rise. The World Health Organization estimates that at least 322 million people in the world suffer from the condition, 18% more than a decade ago. One of the biggest problems with this illness is its tendency to become chronic. Half of patients with depressive disorder are resistant to conventional treatment. They simply do not respond to medication or therapy. That is why alternative ways of treating depression are being tested.

Music is a logical choice: it has been considered an element of cohesion and catharsis since ancient times. The first medical reference to musicology appears in a journal from 1780. But music therapy did not become an organized profession until much later. But its use is highly controversial. In 2022, the Spanish Ministries of Health released a report on pseudosciences, which expressed “low confidence” in music therapy. The report — based on an analysis of scientific publications published in Pubmed between 2012 and 2018 — concluded that there is a “high bias” in the analyses. Of the 10 reviews included, only three suggested that music therapy could have relevant benefits in controlling anxiety or depression.

“It is very ironic and contradictory that it is considered a pseudoscience, while it is being applied successfully in more and more hospitals,” replies David J. Gamella González, director of the Master’s in Music Therapy at the International University of La Rioja in Spain. He himself has used music therapy in intensive care units and critical burn units. “There we see how a patient changes, in the hospital context, where their vital signs are monitored. And we see how with music, in a matter of seconds, the physiology of the body changes.” Gamella praises the new study, arguing that “it confirms phenomena that we have observed through observation for decades.”

Although the effectiveness of this discipline in the medical and psychological fields is disputed, it is clear that listening to music has an impact on the brain. And understanding and measuring it can have implications for the future. “These investigations not only serve to learn how to treat diseases, but also to understand how the brain works,” says Romero Imbroda. The neurologist believes that we are still far from doctors prescribing music specifically, arguing “there is no solid scientific basis for this.” But he recognizes that music can help treat depression. “Just as it is recommended to do sports or foster personal relationships, music can serve as a form of help and prevention,” he says.

The current study sheds light on a little-known brain phenomenon, whose application in a medical context is questioned by the scientific community. More studies are needed to better understand how and why it happens, but it seems clear that music activates multiple regions of the brain. It stimulates the limbic system, which helps process emotions and memories. It reduces levels of cortisol, the hormone the body releases when it is stressed. And it produces dopamine, a neurotransmitter that influences the brain’s reward centers. Popular wisdom says that music is soothing, but the scientific community is still trying to figure out how it has this effect. Finding the answers to these question could open a new avenue for treating depression.

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