title: Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients.
abstract: Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those <60 years in naturalistic clinical practice settings.
  
  
  
  Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 <60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients.
  
  
  
  Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05).
  
  
  
  Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study.
  
  
  
  Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.
authors.affiliation: Bradley Hospital/Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: cconelea@umn.edu.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Conelea
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA.
authors.forename: Noah S
authors.initials: NS
authors.lastname: Philip
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Agustin G
authors.initials: AG
authors.lastname: Yip
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Barnes
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Niedzwiecki
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Greenberg
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Audrey R
authors.initials: AR
authors.lastname: Tyrka
authors.affiliation: Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Carpenter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D057566:Self Report; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Depression; Geriatric; TMS; Transcranial magnetic stimulation