Neuromodulation Therapies for Geriatric Depression

Abstract

Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

“…Four studies reported typical side effects (i.e., itching, tingling, burning) [122], [116], [119], as well as temporary headache and dizziness [111]. It is also worthwhile to note that a review of eight tDCS studies in the geriatric depression literature found no major side effects of stimulation [125]. …”

Efficacy of Noninvasive Brain Stimulation (tDCS or TMS) Paired with Language Therapy in the Treatment of Primary Progressive Aphasia: An Exploratory Meta-Analysis

“…Transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are two widely used methods of noninvasive neuromodulation that offer safe and painless approaches to modulate neuroplasticity [5][6][7][8]. TMS is currently being employed in clinical practice to treat depression [9,10] and other psychiatric conditions, and translational and clinical research exploring both forms of brain stimulation has expanded because these NIBS approaches demonstrate their potential as therapeutic tools for a variety of neurological syndromes [11][12][13][14][15]. While tDCS and TMS differ in a number of ways-from their underlying mechanism(s) of action and impact on the brain to the cost and ease of application-both technologies can be used to enhance or inhibit cortical excitability [16].…”

Late life depression: nursing actions that can help

“…Alternative neuromodulation therapies also provide neurostimulation, but unlike ECT, these therapies do not require anesthetic and have reduced side effects, making them safer for older adults with comorbid medical conditions . Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct‐current stimulation (tDCS) modulate cerebral activity using brain stimulation and are usually implemented over a 4 to 6 week period . In older adults with nonpsychotic depression, rTMS is well tolerated but higher intensities and greater numbers of treatments may be needed than for younger people .…”