Repetitive transcranial magnetic stimulation for treatment of medication-resistant depression in older adults: a case series.
The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) are well documented, but studies to date have produced heterogeneous results in late-life depression.


OBJECTIVE
To address this matter, we evaluated the efficacy of both high- and low-frequency rTMS delivered to the prefrontal cortex of older adults with treatment-resistant major depression.


METHODS
Forty-nine older adults (69 +/- 6.7 years) with treatment-refractory major depressive disorders underwent a series of rTMS treatments as an adjuvant to pharmacotherapy. Patients received high-frequency rTMS delivered to the left dorsolateral prefrontal cortex, low-frequency stimulation to the right dorsolateral prefrontal cortex, or a combination thereof, at 80-110% of the motor threshold.


RESULTS
There was a modest, but statistically significant, mean reduction (24.7%) in Hamilton Depression Rating Scale (HDRS) scores from baseline to the end of treatment. Nine patients were classified as responders (50% HDRS reduction), and 4 patients reached remission status (final HDRS score <8). Similar improvements in HDRS scores were observed for high- and low-frequency rTMS. Treatment was generally well tolerated, and no serious adverse effects were reported.


CONCLUSIONS
The findings support the contention that in older adults with treatment-refractory depression, rTMS can be an effective treatment alternative for some patients.
Milev
Roumen
R
Department of Psychiatry, Queen's University, 752 King Street West, Kingston, Ontario, Canada. milevr@providencecare.ca
Abraham
Gaby
G
Hasey
Gary
G
Cabaj
Jason Lee
JL
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
D000928:Antidepressive Agents