title: Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients.
abstract: Repetitive transcranial magnetic stimulation (rTMS) is a recent putative treatment for affective disorders. Several studies have demonstrated antidepressant effects of rTMS in younger patients; we aimed to assess its effect in older outpatients with treatment-resistant major depression. Twenty-four outpatients (mean age=62 years, S.D.=12) with major depression were randomized for sham or real stimulation and received 10 daily rTMS sessions (20 Hz, 2-s trains, 28-s intertrain intervals, 100% of motor threshold) in addition to the antidepressant medication. For sham stimulation, the coil was tilted 90 degrees. Depression severity was assessed using the Hamilton Depression Rating Scale, the Beck Depression Inventory, items from the NIMH self-rated symptom scale, and a visual analog depression scale. Mini-Mental Status Examination performance, memory, and executive and attentional functions were measured to control for cognitive side effects. Depression ratings revealed significant antidepressant effects within 2 weeks in both sham and real stimulation groups; however, there were no between-group differences. Treatment with rTMS was safe; adverse events were rare and not more prevalent in either group, and cognitive assessment did not show any deterioration. We were unable to demonstrate any additional antidepressant effects of real stimulation in elderly patients with treatment-resistant major depression. Therapeutic effects of rTMS in this clinically challenging patient group remain to be demonstrated.
authors.affiliation: Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK.
authors.forename: Urs P
authors.initials: UP
authors.lastname: Mosimann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmitt
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Greenberg
authors.forename: Markus
authors.initials: M
authors.lastname: Kosel
authors.forename: René M
authors.initials: RM
authors.lastname: Müri
authors.forename: Magdalena
authors.initials: M
authors.lastname: Berkhoff
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hess
authors.forename: Hans U
authors.initials: HU
authors.lastname: Fisch
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Schlaepfer
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010507:Periodicity; D012720:Severity of Illness Index; D012886:Skull; D011795:Surveys and Questionnaires; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation*
chemical_list: D000928:Antidepressive Agents