title: Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls.
abstract: As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation (rTMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rTMS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rTMS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rTMS in the elderly. These factors include but not limited to: (1) brain atrophy; (2) intensity and number of pulses (dose-response relationship); and (3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Priyadharshini
authors.initials: P
authors.lastname: Sabesan
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Lankappa
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Najat
authors.initials: N
authors.lastname: Khalifa
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Vasudevan
authors.initials: V
authors.lastname: Krishnan
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gandhi
authors.affiliation: Priyadharshini Sabesan, Sudheer Lankappa, Najat Khalifa, Vasudevan Krishnan, Rahul Gandhi, Lena Palaniyappan, Nottingham Neuromodulation Unit, Nottinghamshire Healthcare NHS Trust ECT Suite, South Block - A Floor Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Lena
authors.initials: L
authors.lastname: Palaniyappan
keywords: Depression; Geriatric; Neuromodulation; Repetitive transcranial magnetic stimulation; Transcranial magnetic stimulation; Treatment resistance; Treatment resistant depression