Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

Abstract

Background 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. Methods 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. Results 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 Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study. Conclusions 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.

Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder

“…Prior TMS studies indicated that older age was associated with poorer response (Figiel et al, 1998;Manes et al, 2001;Mosimann et al, 2002Mosimann et al, , 2004Su, Huang, & Wei, 2005; but also see Conelea et al, 2017 Limitations of this study are those inherent to a follow-up, exploratory evaluation of a multisite clinical efficacy study. In that study, there was a modest range of demographic features and level of antidepressant resistance that may have limited our ability to detect other clinically significant predictors of response.…”

“…Several predictors of response did not emerge from our analysis. Prior TMS studies indicated that older age was associated with poorer response (Figiel et al., ; Manes et al., ; Mosimann et al., , ; Su, Huang, & Wei, ; but also see Conelea et al., ). This age result was not replicated in the Lisanby et al.…”

High-Frequency Neuronavigated Repetitive Transcranial Magnetic Stimulation for Depression in Major Neurocognitive Disorders: A Randomized Controlled Trial

“…The question as to whether age can be used as a predictor to the e cacy of rTMS is one of the topics ercely debated in recent years. On one hand, initial RCTs indicate that old age may be a poor predictor of the response to rTMS, with lower response rate in elderly patients [45,46], of which this conclusion is not supported by meta-analyses and recent report [48][49][50]. On the other hand, advanced age has been shown to correlate with better response to rTMS [50,51].…”

Identification of clinical features and biomarkers that may inform a personalized approach to rTMS for depression

“…Patient age has been of much interest within the rTMS treatment literature and investigations into the relationship between age and rTMS efficacy have largely produced mixed results. A number of rTMS studies have found support for the notion that rTMS may be less effective for depression in older individuals (e.g., [5,[14][15][16]), while others have not found age to be a significant predictor of rTMS outcomes (e.g., [6,7,17,18]). At least one group has found the relationship between age and rTMS outcome to be curvilinear [19].…”