Late-life depression is a serious concern that affects the well-being and quality of life of older adults. Traditional treatment methods, such as medication and psychotherapy, may not always be effective, especially in severe or treatment-resistant cases. Neurostimulation modalities, including Electroconvulsive Therapy (ECT), Repetitive Transcranial Magnetic Stimulation (rTMS), and Deep Transcranial Magnetic Stimulation (Deep TMS), offer promising alternatives. This blog explores these modalities, their efficacy, and their specific implications for older adults.
Electroconvulsive Therapy (ECT)
ECT involves administering electrical impulses to the brain under general anesthesia to induce controlled seizures, which can quickly reduce severe depressive symptoms. Meta-analyses confirm its efficacy, particularly in treatment-resistant cases. However, ECT’s side effects, such as memory loss and confusion, are significant, especially in older adults, and the procedure’s need for anesthesia and hospital visits can be taxing.
Repetitive Transcranial Magnetic Stimulation (rTMS)
rTMS is a non-invasive procedure using magnetic fields to stimulate specific brain areas involved in mood regulation. Administered daily over several weeks, clinical trials have shown its effectiveness in treating depression. However, the outcomes achieved with older age patients have been limited relative to those achieved with younger patients treated with rTMS, likely due to age-related brain atrophy and other factors.
Deep Transcranial Magnetic Stimulation (Deep TMS)
Deep TMS uses specialized H-coils to reach deeper and broader brain areas compared to traditional rTMS, aiming to overcome some of these limitations. Recent studies show promise for Deep TMS in treating late-life depression, as demonstrated below.
Efficacy of Deep TMS
Open-label, naturalistic data assessed Deep TMS’s safety and efficacy in late-life depression in 247 patients aged 60-91 receiving 20 or more sessions. These patients had an average history of 8.5 depressive episodes and were on average taking 12 concomitant antidepressant medications.
Results showed that after 30 sessions, there was a response rate of 79.4% and a remission rate of 60.3% on the most-rated scale. The median onset of response was 14 sessions (20 days), and for remission, it was 15 sessions (23 days). Comparing these results with a recent large naturalistic study of Deep TMS in middle-aged adults with Major Depressive Disorder (MDD), the response rates, remission rates, and the median number of sessions/days required to reach response/remission were found to be comparable.
For more details, visit Brainsway’s article on Deep TMS.
Safety of Deep TMS
Deep TMS has not been shown to cause any systemic side effects. A 2007 study in Clinical Neurophysiology confirmed this, finding Deep TMS to be a well-tolerated treatment with no systemic side effects.
Individuals undergoing Deep TMS treatment may experience a slight discomfort during the procedure, with some reporting a tapping sensation in the area being treated. In the double-blind randomized controlled trial of 52 late-life depression patients, no serious adverse events were observed. The only side effect significantly more common in the active Deep TMS group than sham was pain (16.0% vs 0%). Additionally, 56% of patients receiving active Deep TMS treatment experienced headaches after treatment, though this was not significantly different from the sham treatment group (37%).
Conclusion
Neurostimulation modalities, especially Deep TMS, present a promising avenue for treating late-life depression. While ECT and rTMS have their benefits and limitations, Deep TMS stands out due to its ability to target deeper brain areas, its high efficacy rates, and minimal side effects. It’s crucial for healthcare providers to consider these innovative treatments and offer them to older adults struggling with depression, thereby improving their quality of life and overall well-being.
For more information on how Deep TMS can help with late-life depression, visit Brainsway’s website.