Neuromodulation Therapies in the Elderly Depressed Patient

Manepalli, Jothika; Sapkota, Nidesh

doi:10.1007/s13670-014-0098-1

Cited by 5 publications

(6 citation statements)

References 70 publications

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“…There are no cognitive adverse effects reported with rTMS. In 2008, the FDA approved rTMS as a treatment for depression for patients not responding to at least one antidepressant medication with a maximum age of 69 [29]. …”

Section: Introductionmentioning

confidence: 99%

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A Review of Brain Stimulation Treatments for Late-Life Depression

Blumberger

Hsu

Daskalakis

2015

Curr Treat Options Psych

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Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults have not been systematically included in clinical trials. Repetitive transcranial magnetic stimulation has demonstrated efficacy in younger adults and there is emerging data to support its use in late-life depression (LLD). It will be imperative that older adults be included in future transcranial direct current stimulation and magnetic seizure therapy clinical trials. Unclear efficacy results are a concern for both vagus nerve stimulation and deep brain stimulation.

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Section: Introductionmentioning

confidence: 99%

“…VNS was initially approved by the FDA for treatment of refractory epilepsy in 1997 [29]. It was investigated for its antidepressant effects after improvement in mood in treated patients and in 2005, it was approved as a therapy for TRD by the FDA.…”

Section: Introductionmentioning

confidence: 99%

A Review of Brain Stimulation Treatments for Late-Life Depression

Blumberger

Hsu

Daskalakis

2015

Curr Treat Options Psych

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“…[11] The mechanism of action is unknown, but another study has shown a significant increase in cerebral gabaaminobutyric acid (GABA) after ECT. [2,12] PET scans done pre-ECT and after a course of ECT showed a decrease in the cerebral metabolism in prefrontal and parietal areas, and this reduction correlated with improvement in depression. [2,13] Middle-aged and elderly patients have a higher remission rate after a course of ECT than younger patients.…”

mentioning

confidence: 87%

“…Major depressive disorder (MDD) in the elderly is a potentially debilitating condition, which rapidly progresses to a severe stage and can be resistant to pharmacological intervention and psychotherapy. [1,2] In this age group depression is reported to decrease the overall quality of life and because of decreased mobility, compromised food and fluid intake, and a higher incidence of lethal suicide attempts than in younger people, depression should be considered a life-threatening disease. [3,4] For the elderly who develop major depression, particularly in cases of psychotic depression or when antidepressant treatment fails, electroconvulsive therapy (ECT) remains a safe and effective treatment with an 80% to 90% remission rate.…”

Section: Commentmentioning

confidence: 99%

“…This treatment is done under general anesthesia and in a controlled environment where the patient is monitored. [2] Furthermore, the increased blood flow in the thalamus following ECT may also be related to the therapeutic effects of ECT because depression is characterised by symptoms of diencephalic disturbances. [9,10,11] Although repeated ECT is generally necessary for ameliorating depressive symptoms, the antidepressant effects of ECT are probably associated with changes in blood flow in the anterior cingulate and medial frontal córtex and thalamus.…”

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confidence: 99%

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The Efficiency Of Electroconvulsive Therapy In The Treatment Of Depression In The Elderly

Lima¹,

Alencar²,

Carneiro³

et al. 2015

Int Arch Med

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The Electroconvulsive Therapy (ECT) is a safe and effective treatment of depression in the elderly. With a high rate of remission may be the treatment of choice in cases of psychotic depression or when antidepressant treatment fails. Although its mechanism of action is unknown the therapeutic effects of ECT may be related to changes in cerebral blood flow. Studies confirm differences in the effects of ECT according to patient age. There are side effects related to cognitive function. ECT is as safe for elderly patients and for young patients.

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An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Co-morbid Pain and Depressive Symptoms

Hsu

Daskalakis

Blumberger

2018

Curr Pain Headache Rep

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Recent meta-analyses have included both pain and depression outcomes in fibromyalgia and chronic pain. Randomized controlled trials have also been conducted in post-herpetic neuralgia, trauma-related headache, and neuropathic pain with attention to both pain and depressive symptoms. In general, studies have demonstrated reduction in pain in patients with fibromyalgia as an add-on treatment, post-herpetic neuralgia, trauma-related headache, and neuropathic pain. There are variable findings for reduction in depressive symptoms in patients with co-morbid pain disorders. Theta burst stimulation (TBS) is a novel rTMS protocol that has recently been investigated in patients with depression and some smaller trials in patients with co-morbid pain disorders. These emerging treatment options may have similar or greater therapeutic potency and may be delivered with greater efficiency. There is evidence to support the use of rTMS for its analgesic effects in various pain syndromes. The variable results between trials for treatment of concurrent depressive symptoms may be due to heterogeneity in treatment protocols including parameters such as site of stimulation (primary motor cortex versus dorsolateral prefrontal cortex) and restrictions in the patient population which usually exclude primary psychiatric diagnoses. Future trials should work to standardize these protocols, investigate novel protocols like TBS, and continue to include standardized assessment of concurrent psychiatric outcomes such as depression and anxiety.

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Neuromodulation Therapies in the Elderly Depressed Patient

Cited by 5 publications

References 70 publications

A Review of Brain Stimulation Treatments for Late-Life Depression

A Review of Brain Stimulation Treatments for Late-Life Depression

The Efficiency Of Electroconvulsive Therapy In The Treatment Of Depression In The Elderly

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Co-morbid Pain and Depressive Symptoms

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