Skip to main content

Advertisement

SpringerLink
Log in

Neuromodulation Therapies for Geriatric Depression

  • Geriatric Disorders (W McDonald, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Van der Wurff FB, Stek ML, Hoogendijk WL, Beekman AT. Electroconvulsive therapy for the depressed elderly. Cochrane Database Syst Rev. 2003;(2):CD003593.

  2. Katon WJ, Lin E, Russo J, Unutzer J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry. 2003;60:897–903.

    PubMed  Google Scholar 

  3. Ismail Z, Fischer C, McCall WV. What characterizes late-life depression? Psychiatr Clin North Am. 2013;36:483–96.

    PubMed  Google Scholar 

  4. Dillon C, Allegri RF, Serrano CM, Iturry M, Salgado P, Glaser FB, et al. Late- versus early-onset geriatric depression in a memory research center. Neuropsychiatr Dis Treat. 2009;5:517–26.

    PubMed Central  PubMed  Google Scholar 

  5. Aziz R, Steffens DC. What are the causes of late-life depression? Psychiatr Clin North Am. 2013;36:497–516.

    PubMed Central  PubMed  Google Scholar 

  6. Katona CL. Psychotropics and drug interactions in the elderly patient. Int J Geriatr Psychiatry. 2001;16 Suppl 1:S86–90.

    PubMed  Google Scholar 

  7. Beekman AT, Geerlings SW, Deeg DJ, Smit JH, Schoevers RS, de Beurs E, et al. The natural history of late-life depression: a 6-year prospective study in the community. Arch Gen Psychiatry. 2002;59:605–11.

    PubMed  Google Scholar 

  8. Reynolds 3rd CF, Frank E, Kupfer DJ, Thase ME, Perel JM, Mazumdar S, et al. Treatment outcome in recurrent major depression: a post hoc comparison of elderly ("young old") and midlife patients. Am J Psychiatry. 1996;153:1288–92.

    PubMed  Google Scholar 

  9. Cooper C, Katona C, Lyketsos K, Blazer D, Brodaty H, Rabins P, et al. A systematic review of treatments for refractory depression in older people. Am J Psychiatry. 2011;168:681–8.

    PubMed  Google Scholar 

  10. Dew MA, Whyte EM, Lenze EJ, Houck PR, Mulsant BH, Pollock BG, et al. Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy. Am J Psychiatry. 2007;164:892–9.

    PubMed  Google Scholar 

  11. Coffey CE, Fochtmann LJ, Greenberg RM, Isenberg KE, Kellner CH, Moench LA, et al. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. 2nd ed. Washington, D.C: American Psychiatric Association; 2001.

    Google Scholar 

  12. Leiknes KA, Jarosh-von Schweder L, Hoie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav. 2012;2:283–344.

    PubMed Central  PubMed  Google Scholar 

  13. Glen T, Scott AI. Rates of electroconvulsive therapy use in Edinburgh (1992–1997). J Affect Disord. 1999;54:81–5.

    CAS  PubMed  Google Scholar 

  14. Plakiotis C, George K, O'Connor DW. Is electroconvulsive therapy use among young-old and old-old adults comparable? A 10-year population-level analysis of service provision. J ECT. 2014;30:232–41.

    PubMed  Google Scholar 

  15. Chanpattana W. A questionnaire survey of ECT practice in Australia. J ECT. 2007;23:89–92.

    PubMed  Google Scholar 

  16. Organization WH. Figures and Facts About Suicide. In: Department of Mental Health WHO, editor. Geneva, Switzerland: http://whqlibdoc.who.int/hq/1999/WHO_MNH_MBD_99.1.pdf; 1999. p. 1–122.

  17. Pearson JL. Recent research on suicide in the elderly. Curr Psychiatry Rep. 2002;4:59–63.

    PubMed  Google Scholar 

  18. Conwell Y, Duberstein PR, Cox C, Herrmann J, Forbes N, Caine ED. Age differences in behaviors leading to completed suicide. Am J Geriatr Psychiatry. 1998;6:122–6.

    CAS  PubMed  Google Scholar 

  19. McCall WV, Cohen W, Reboussin B, Lawton P. Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: a hypothesis regarding why the elderly are more likely to receive ECT. J ECT. 1999;15:193–201.

    CAS  PubMed  Google Scholar 

  20. Mulsant BH, Houck PR, Gildengers AG, Andreescu C, Dew MA, Pollock BG, et al. What is the optimal duration of a short-term antidepressant trial when treating geriatric depression? J Clin Psychopharmacol. 2006;26:113–20.

    PubMed  Google Scholar 

  21. Group UER. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361:799–808.

    Google Scholar 

  22. Spaans HP, Sienaert P, Bouckaert F, van den Berg JF, Verwijk E, Kho KH, et al. Speed of remission in elderly patients with depression: electroconvulsive therapy v. medication. Br J Psychiatry. 2015;206:67–71. First study evidencing ECT is superior to pharmacotherapy in the treatment of severe unipolar geriatric depression.

    PubMed  Google Scholar 

  23. Kok RM, Nolen WA, Heeren TJ. Venlafaxine versus nortriptyline in the treatment of elderly depressed inpatients: a randomised, double-blind, controlled trial. Int J Geriatr Psychiatry. 2007;22:1247–54.

    PubMed  Google Scholar 

  24. Spaans HP, Verwijk E, Comijs HC, Kok RM, Sienaert P, Bouckaert F, et al. Efficacy and cognitive side effects after brief pulse and ultrabrief pulse right unilateral electroconvulsive therapy for major depression: a randomized, double-blind, controlled study. J Clin Psychiatry. 2013;74:e1029–36.

    PubMed  Google Scholar 

  25. Paykel ES. Achieving gains beyond response. Acta Psychiatr Scand Suppl. 2002;415:12–7.

  26. O'Connor MK, Knapp R, Husain M, Rummans TA, Petrides G, Smith G, et al. The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. Am J Geriatr Psychiatry. 2001;9:382–90.

    PubMed  Google Scholar 

  27. van der Wurff FB, Stek ML, Hoogendijk WJ, Beekman AT. The efficacy and safety of ECT in depressed older adults: a literature review. Int J Geriatr Psychiatry. 2003;18:894–904.

    PubMed  Google Scholar 

  28. Tew Jr JD, Mulsant BH, Haskett RF, Prudic J, Thase ME, Crowe RR, et al. Acute efficacy of ECT in the treatment of major depression in the old-old. Am J Psychiatry. 1999;156:1865–70.

    PubMed  Google Scholar 

  29. Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry. 2010;196:226–34.

    PubMed Central  PubMed  Google Scholar 

  30. Sanghani SPG, Knapp R, Husain M, Sampson S, Bailine S, Rasmussen K, et al. Differential Effect of Three Electrode Placements in Older vs Younger Patients with Severe Depression treated with Electroconvulsive Therapy (ECT). Am J Geriatr Psychiatry. 2014;22:S114.

    Google Scholar 

  31. Rhebergen D, Huisman A, Bouckaert F, Kho K, Kok R, Sienaert P, et al. Older age is associated with rapid remission of depression after electroconvulsive therapy: a latent class growth analysis. Am J Geriatr Psychiatry. 2015;23(3):274–82. ECT predicts rapid remission in the elderly, even after controlling for potential confounders (e.g. age, gender, pulse-width).

    PubMed  Google Scholar 

  32. Coffey CE, Figiel GS, Djang WT, Weiner RD. Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. Am J Psychiatry. 1990;147:187–9.

    CAS  PubMed  Google Scholar 

  33. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. 'Vascular depression' hypothesis. Arch Gen Psychiatry. 1997;54:915–22.

    CAS  PubMed  Google Scholar 

  34. Fink M. Electroshock revisited. Am Sci. 2000;88:162–7.

    Google Scholar 

  35. Brodaty H, Luscombe G, Parker G, Wilhelm K, Hickie I, Austin MP, et al. Increased rate of psychosis and psychomotor change in depression with age. Psychol Med. 1997;27:1205–13.

    CAS  PubMed  Google Scholar 

  36. Hickie I, Mason C, Parker G, Brodaty H. Prediction of ECT response: validation of a refined sign-based (CORE) system for defining melancholia. Br J Psychiatry. 1996;169:68–74.

    CAS  PubMed  Google Scholar 

  37. Rasmussen KG. Electroconvulsive therapy and melancholia: review of the literature and suggestions for further study. J ECT. 2011;27:315–22.

    PubMed  Google Scholar 

  38. Oudega ML, van Exel E, Stek ML, Wattjes MP, van der Flier WM, Comijs HC, et al. The structure of the geriatric depressed brain and response to electroconvulsive therapy. Psychiatry Res. 2014;222:1–9. Specific structural alterations in the geriatric brain might predict response and speed of response to ECT.

    PubMed  Google Scholar 

  39. Oudega ML, van Exel E, Wattjes MP, Comijs HC, Scheltens P, Barkhof F, et al. White matter hyperintensities, medial temporal lobe atrophy, cortical atrophy, and response to electroconvulsive therapy in severely depressed elderly patients. J Clin Psychiatry. 2011;72:104–12.

    PubMed  Google Scholar 

  40. Aizenstein HJ, Khalaf A, Walker SE, Andreescu C. Magnetic resonance imaging predictors of treatment response in late-life depression. J Geriatr Psychiatry Neurol. 2014;27:24–32.

    PubMed Central  PubMed  Google Scholar 

  41. O'Connor DW, Gardner B, Eppingstall B, Tofler D. Cognition in elderly patients receiving unilateral and bilateral electroconvulsive therapy: a prospective, naturalistic comparison. J Affect Disord. 2010;124:235–40.

    PubMed  Google Scholar 

  42. Stoppe A, Louza M, Rosa M, Gil G, Rigonatti S. Fixed high-dose electroconvulsive therapy in the elderly with depression: a double-blind, randomized comparison of efficacy and tolerability between unilateral and bilateral electrode placement. J ECT. 2006;22:92–9.

    PubMed  Google Scholar 

  43. Bjolseth TM, Engedal K, Benth JS, Dybedal GS, Gaarden TL, Tanum L. Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord. 2014;175C:8–17.

    Google Scholar 

  44. Loo CK, Katalinic N, Smith DJ, Ingram A, Dowling N, Martin D et al. A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy. Int J Neuropsychopharmacol. 2014;18. doi: 10.1093/ijnp/pyu045.

  45. Tor PC, Bautovich A, Wang MJ, Martin D, Harvey S, Loo CK. A Systematic Review and Meta–Analysis of Brief versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression. J Clin Psych. 2015. In press.

  46. Loo CK, Sainsbury K, Sheehan P, Lyndon B. A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT. Int J Neuropsychopharmacol. 2008;11:883–90.

    PubMed  Google Scholar 

  47. Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008;1:71–83.

    PubMed Central  PubMed  Google Scholar 

  48. Coffey CE, Cummings JL. Electroconvulsive Therapy. Textbook of Geriatric Neuropsychiatry. 2nd ed. Washington DC: American Psychiatric Press; 2000. p. 829–59.

    Google Scholar 

  49. Sackeim HA, Decina P, Portnoy S, Neeley P, Malitz S. Studies of dosage, seizure threshold, and seizure duration in ECT. Biol Psychiatry. 1987;22:249–68.

    CAS  PubMed  Google Scholar 

  50. Gálvez V, Hadzi-Pavlovic D, Smith D, Loo CK. Predictors of seizure threshold in right unilateral ultrabrief electroconvulsive therapy: role of concomitant medications and anaesthesia used. Brain Stimul. 2015. doi:10.1016/j.brs.2014.12.012.

    PubMed  Google Scholar 

  51. Mayur P, Byth K, Harris A. Acute antidepressant effects of right unilateral ultra-brief ECT: a double-blind randomised controlled trial. J Affect Disord. 2013;149:426–9.

    PubMed  Google Scholar 

  52. Coffey CE, Lucke J, Weiner RD, Krystal AD, Aque M. Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT. Biol Psychiatry. 1995;37:777–88.

    CAS  PubMed  Google Scholar 

  53. Krystal AD, Coffey CE, Weiner RD, Holsinger T. Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings. J Neuropsychiatry Clin Neurosci. 1998;10:178–86.

    CAS  PubMed  Google Scholar 

  54. Loo CK, Mahon M, Katalinic N, Lyndon B, Hadzi-Pavlovic D. Predictors of response to ultrabrief right unilateral electroconvulsive therapy. J Affect Disord. 2011;130:192–7.

    PubMed  Google Scholar 

  55. Kellner CH, Lisanby SH, Weiner R, Prudic J, Rudorfer MV, Young RC, et al. Speed of response to electroconvulsive therapy compared with ketamine. Psychiatry Res. 2015;225:215. Preliminary data suggests ultrabrief right unilateral ECT might be an efficacious, fast and safe ECT modality for the elderly depressed.

    PubMed  Google Scholar 

  56. Lisanby SH, Husain MM, Knapp RG, Mueller M, McCall VW, Petrides G, et al. Ultrabrief right unilateral ECT in geriatric depression: antidepressant and cognitive outcomes. Abstracts from 69th Annual Scientific and Convention Meeting. Biol Psychiatry. 2014;75:9S.

    Google Scholar 

  57. van Schaik AM, Comijs HC, Sonnenberg CM, Beekman AT, Sienaert P, Stek ML. Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review. Am J Geriatr Psychiatry. 2012;20:5–17.

    PubMed  Google Scholar 

  58. Verwijk E, Comijs HC, Kok RM, Spaans HP, Tielkes CE, Scherder EJ, et al. Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study. Int Psychogeriatr. 2014;26:315–24.

    PubMed  Google Scholar 

  59. Gardner BK, O'Connor DW. A review of the cognitive effects of electroconvulsive therapy in older adults. J ECT. 2008;24:68–80.

    PubMed  Google Scholar 

  60. Tielkes CE, Comijs HC, Verwijk E, Stek ML. The effects of ECT on cognitive functioning in the elderly: a review. Int J Geriatr Psychiatry. 2008;23:789–95.

    PubMed  Google Scholar 

  61. Plakiotis C, Chin LF, O'Connor DW. Are reports of cognitive testing among older electroconvulsive therapy recipients clinically valid? J ECT. 2014;30:26–9.

    PubMed  Google Scholar 

  62. Abete P, Della-Morte D, Gargiulo G, Basile C, Langellott A, Galizia G, et al. Cognitive impairment and cardiovascular diseases in the elderly. A heart-brain continuum hypothesis. Ageing Res Rev. 2014;18C:41–52.

    Google Scholar 

  63. Figiel GS, Coffey CE, Weiner RD. Brain Magnetic Resonance Imaging in Elderly Depressed Patients Receiving Electroconvulsive Therapy. Convuls Ther. 1989;5:26–34.

    PubMed  Google Scholar 

  64. Figiel GS, Coffey CE, Djang WT, Hoffman Jr G, Doraiswamy PM. Brain magnetic resonance imaging findings in ECT-induced delirium. J Neuropsychiatry Clin Neurosci. 1990;2:53–8.

    CAS  PubMed  Google Scholar 

  65. Legendre SA, Stern RA, Solomon DA, Furman MJ, Smith KE. The influence of cognitive reserve on memory following electroconvulsive therapy. J Neuropsychiatry Clin Neurosci. 2003;15:333–9.

    PubMed  Google Scholar 

  66. Bai S, Loo C, Al Abed A, Dokos S. A computational model of direct brain excitation induced by electroconvulsive therapy: comparison among three conventional electrode placements. Brain Stimul. 2012;5:408–21.

    PubMed  Google Scholar 

  67. Bai S, Loo C, Dokos S. Effects of electroconvulsive therapy stimulus pulsewidth and amplitude computed with an anatomically-realistic head model. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:2559–62.

    PubMed  Google Scholar 

  68. Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007;32:244–54.

    PubMed  Google Scholar 

  69. Riva-Posse P, Hermida AP, McDonald WM. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression. Psychiatr Clin North Am. 2013;36:607–30.

    PubMed  Google Scholar 

  70. Rivera FA, Lapid MI, Sampson S, Mueller PS. Safety of electroconvulsive therapy in patients with a history of heart failure and decreased left ventricular systolic heart function. J ECT. 2011;27:207–13.

    PubMed  Google Scholar 

  71. Mueller PS, Albin SM, Barnes RD, Rasmussen Jr KG. Safety of electroconvulsive therapy in patients with unrepaired abdominal aortic aneurysm: report of 8 patients. J ECT. 2009;25:165–9.

    PubMed  Google Scholar 

  72. O'Reardon JP, Cristancho MA, Ryley B, Patel KR, Haber HL. Electroconvulsive therapy for treatment of major depression in a 100-year-old patient with severe aortic stenosis: a 5-year follow-up report. J ECT. 2011;27:227–30.

    PubMed Central  PubMed  Google Scholar 

  73. de Carle AJ, Kohn R. Risk factors for falling in a psychogeriatric unit. Int J Geriatr Psychiatry. 2001;16:762–7.

    PubMed  Google Scholar 

  74. Cattan RA, Barry PP, Mead G, Reefe WE, Gay A, Silverman M. Electroconvulsive therapy in octogenarians. J Am Geriatr Soc. 1990;38:753–8.

    CAS  PubMed  Google Scholar 

  75. Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014;44:225–39.

    CAS  PubMed  Google Scholar 

  76. Su TP, Huang CC, Wei IH. Add-on rTMS for medication-resistant depression: a randomized, double-blind, sham-controlled trial in Chinese patients. J Clin Psychiatry. 2005;66:930–7.

    PubMed  Google Scholar 

  77. Padberg F, Zwanzger P, Thoma H, Kathmann N, Haag C, Greenberg BD, et al. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS. Psychiatry Research. 1999;88(3):163–171

  78. Fregni F, Marcolin MA, Myczkowski M, Amiaz R, Hasey G, Rumi DO, et al. Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. Int J Neuropsychopharmacol. 2006;9:641–54.

    CAS  PubMed  Google Scholar 

  79. Aguirre I, Carretero B, Ibarra O, Kuhalainen J, Martinez J, Ferrer A, et al. Age predicts low-frequency transcranial magnetic stimulation efficacy in major depression. J Affect Disord. 2011;130:466–9.

    PubMed  Google Scholar 

  80. Pallanti S, Cantisani A, Grassi G, Antonini S, Cecchelli C, Burian J, et al. rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review. CNS Spectr. 2012;17:24–30.

    PubMed  Google Scholar 

  81. Figiel GS, Epstein C, McDonald WM, Amazon-Leece J, Figiel L, Saldivia A, et al. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neurosci. 1998;10:20–5.

    CAS  PubMed  Google Scholar 

  82. Lee JC, Blumberger DM, Fitzgerald PB, Daskalakis ZJ, Levinson AJ. The role of transcranial magnetic stimulation in treatment-resistant depression: a review. Curr Pharm Des. 2012;18:5846–52.

    CAS  PubMed  Google Scholar 

  83. Kozel FA, Nahas Z, de Brux C, Molloy M, Lorberbaum JP, Bohning D, et al. How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation. J Neuropsychiatry Clin Neurosci. 2000;12:376–84.

  84. Lisanby SH, Husain MM, Rosenquist PB, Maixner D, Gutierrez R, Krystal A, et al. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology. 2009;34:522–34.

    PubMed  Google Scholar 

  85. Herwig U, Fallgatter AJ, Hoppner J, Eschweiler GW, Kron M, Hajak G, et al. Antidepressant effects of augmentative transcranial magnetic stimulation: randomised multicentre trial. Br J Psychiatry. 2007;191:441–8.

    CAS  PubMed  Google Scholar 

  86. Mogg A, Pluck G, Eranti SV, Landau S, Purvis R, Brown RG, et al. A randomized controlled trial with 4-month follow-up of adjunctive repetitive transcranial magnetic stimulation of the left prefrontal cortex for depression. Psychol Med. 2008;38:323–33.

    CAS  PubMed  Google Scholar 

  87. Brakemeier EL, Luborzewski A, Danker-Hopfe H, Kathmann N, Bajbouj M. Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS). J Psychiatr Res. 2007;41:395–403.

    PubMed  Google Scholar 

  88. Allan CL, Herrmann LL, Ebmeier KP. Transcranial magnetic stimulation in the management of mood disorders. Neuropsychobiology. 2011;64:163–9.

    PubMed  Google Scholar 

  89. Kedzior KK, Reitz SK. Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression- reanalysis of data from meta-analyses up to 2010. BMC Psychol. 2014;2:39. doi:10.1186/s40359-014-0039-y. Recent meta-analysis. Age is not found a predictor of response of rTMS.

    PubMed Central  PubMed  Google Scholar 

  90. Hizli Sayar G, Ozten E, Tan O, Tarhan N. Transcranial magnetic stimulation for treating depression in elderly patients. Neuropsychiatr Dis Treat. 2013;9:501–4. Most recent study examining efficacy and safety of rTMS for geriatric depression.

    PubMed  Google Scholar 

  91. Jorge RE, Moser DJ, Acion L, Robinson RG. Treatment of vascular depression using repetitive transcranial magnetic stimulation. Arch Gen Psychiatry. 2008;65:268–76.

    PubMed  Google Scholar 

  92. Jorge RE, Robinson RG, Tateno A, Narushima K, Acion L, Moser D, et al. Repetitive transcranial magnetic stimulation as treatment of poststroke depression: a preliminary study. Biol Psychiatry. 2004;55:398–405.

    PubMed  Google Scholar 

  93. Abraham G, Milev R, Lazowski L, Jokic R, du Toit R, Lowe A. Repetitive transcranial magnetic stimulation for treatment of elderly patients with depression - an open label trial. Neuropsychiatr Dis Treat. 2007;3:919–24.

    PubMed Central  PubMed  Google Scholar 

  94. Milev R, Abraham G, Hasey G, Cabaj JL. Repetitive transcranial magnetic stimulation for treatment of medication-resistant depression in older adults: a case series. J ECT. 2009;25:44–9.

    PubMed  Google Scholar 

  95. Fabre I, Galinowski A, Oppenheim C, Gallarda T, Meder JF, De Montigny C, et al. Antidepressant efficacy and cognitive effects of repetitive transcranial magnetic stimulation in vascular depression: an open trial. Int J Geriatr Psychiatry. 2004;19:833–42.

    CAS  PubMed  Google Scholar 

  96. Coffey CE, Wilkinson WE, Weiner RD, Parashos IA, Djang WT, Webb MC, et al. Quantitative cerebral anatomy in depression. A controlled magnetic resonance imaging study. Arch Gen Psychiatry. 1993;50:7–16.

    CAS  PubMed  Google Scholar 

  97. Wagner T, Eden U, Fregni F, Valero-Cabre A, Ramos-Estebanez C, Pronio-Stelluto V, et al. Transcranial magnetic stimulation and brain atrophy: a computer-based human brain model study. Exp Brain Res. 2008;186:539–50.

    PubMed Central  PubMed  Google Scholar 

  98. Mosimann UP, Marre SC, Werlen S, Schmitt W, Hess CW, Fisch HU, et al. Antidepressant effects of repetitive transcranial magnetic stimulation in the elderly: correlation between effect size and coil-cortex distance. Arch Gen Psychiatry. 2002;59:560–1.

    PubMed  Google Scholar 

  99. Nahas Z, Li X, Kozel FA, Mirzki D, Memon M, Miller K, et al. Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55–75 years of age: a pilot study. Depress Anxiety. 2004;19:249–56.

    PubMed  Google Scholar 

  100. Janicak PG, Dowd SM, Martis B, Alam D, Beedle D, Krasuski J, et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: preliminary results of a randomized trial. Biol Psychiatry. 2002;51:659–67.

    PubMed  Google Scholar 

  101. Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry. 2003;160:835–45.

    PubMed  Google Scholar 

  102. Grunhaus L, Dannon PN, Schreiber S, Dolberg OH, Amiaz R, Ziv R, et al. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study. Biol Psychiatry. 2000;47:314–24.

    CAS  PubMed  Google Scholar 

  103. Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010;71:873–84.

    PubMed  Google Scholar 

  104. Ren J, Li H, Palaniyappan L, Liu H, Wang J, Li C, et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2014;51:181–9. Recent meta-analysis comparing efficacy of ECT and rTMS. Psychotic depression responds better to ECT than rTMS.

    PubMed  Google Scholar 

  105. Mosimann UP, Schmitt W, Greenberg BD, Kosel M, Muri RM, Berkhoff M, et al. Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients. Psychiatry Res. 2004;126:123–33.

    PubMed  Google Scholar 

  106. Manes F, Jorge R, Morcuende M, Yamada T, Paradiso S, Robinson RG. A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly. Int Psychogeriatr. 2001;13:225–31.

    CAS  PubMed  Google Scholar 

  107. Moser DJ, Jorge RE, Manes F, Paradiso S, Benjamin ML, Robinson RG. Improved executive functioning following repetitive transcranial magnetic stimulation. Neurology. 2002;58:1288–90.

    CAS  PubMed  Google Scholar 

  108. Arul-Anandam AP, Loo C. Transcranial direct current stimulation: a new tool for the treatment of depression? J Affect Disord. 2009;117:137–45.

    PubMed  Google Scholar 

  109. Kalu UG, Sexton CE, Loo CK, Ebmeier KP. Transcranial direct current stimulation in the treatment of major depression: a meta-analysis. Psychol Med. 2012;42:1791–800.

    CAS  PubMed  Google Scholar 

  110. Shiozawa P, Fregni F, Benseñor IM, Lotufo PA, Berlim MT, Daskalakis JZ, et al. Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis. Int J Neuropsychopharmacol. 2014;17:1443–52. Most recent systematic review and meta-analysis of tDCS in depression.

    PubMed  Google Scholar 

  111. Shiozawa P, da Silva ME, Dias DR, Chaves AC, de Oliveira Diniz BS, Cordeiro Q. Transcranial direct current stimulation for depression in a 92-year-old patient: a case study. Psychogeriatrics. 2014;14:269–70. First case report of the use of tDCS to treat depression in a 92-year-old patient.

    PubMed  Google Scholar 

  112. Loo CK, Alonzo A, Martin D, Mitchell PB, Galvez V, Sachdev P. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry. 2012;200:52–9. RCT of tDCS in depression with the largest sample of elderly participants to date. Suggests potential antidepressant efficacy with minimal negative side when tDCS is given at adequate stimulus parameters.

    PubMed  Google Scholar 

  113. Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Salvoro B, Giacopuzzi M, et al. Transcranial direct current stimulation in severe, drug-resistant major depression. J Affect Disord. 2009;118:215–9.

    CAS  PubMed  Google Scholar 

  114. Loo CK, Sachdev P, Martin D, Pigot M, Alonzo A, Malhi GS, et al. A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Int J Neuropsychopharmacol. 2010;13:61–9.

    PubMed  Google Scholar 

  115. Palm U, Schiller C, Fintescu Z, Obermeier M, Keeser D, Reisinger E, et al. Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Brain Stimul. 2012;5:242–51.

    CAS  PubMed  Google Scholar 

  116. Palm U, Keeser D, Schiller C, Fintescu Z, Reisinger E, Baghai TC, et al. Transcranial direct current stimulation in a patient with therapy-resistant major depression. World J Biol Psychiatry. 2009;10:632–5.

    PubMed  Google Scholar 

  117. Brunoni AR, Boggio PS, De Raedt R, Bensenor IM, Lotufo PA, Namur V, et al. Cognitive control therapy and transcranial direct current stimulation for depression: a randomized, double-blinded, controlled trial. J Affect Disord. 2014;162:43–9.

    CAS  PubMed  Google Scholar 

  118. Brunoni AR, Valiengo L, Baccaro A, Zanao TA, de Oliveira JF, Goulart A, et al. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013;70:383–91.

    CAS  PubMed  Google Scholar 

  119. Demirtas-Tatlidede A, Vahabzadeh-Hagh AM, Pascual-Leone A. Can noninvasive brain stimulation enhance cognition in neuropsychiatric disorders? Neuropharmacology. 2013;64:566–78.

    CAS  PubMed Central  PubMed  Google Scholar 

  120. Loo CK, Martin DM. Could transcranial direct current stimulation have unexpected additional benefits in the treatment of depressed patients? Expert Rev Neurother. 2012;12:751–3.

    CAS  PubMed  Google Scholar 

  121. Mondino M, Bennabi D, Poulet E, Galvao F, Brunelin J, Haffen E. Can transcranial direct current stimulation (tDCS) alleviate symptoms and improve cognition in psychiatric disorders? World J Biol Psychiatry. 2014;15:261–75.

    PubMed  Google Scholar 

  122. Fregni F, Boggio PS, Nitsche MA, Rigonatti SP, Pascual-Leone A. Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Depress Anxiety. 2006;23:482–4.

    PubMed  Google Scholar 

  123. Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, et al. Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects. Brain Stimul. 2013;6:631–40.

    PubMed  Google Scholar 

  124. Puigdemont D, Portella MJ, Perez-Egea R, de Diego-Adelino J, Gironell A, Molet J, et al. Depressive relapse after initial response to subcallosal cingulate gyrus-deep brain stimulation in a patient with a treatment-resistant depression: electroconvulsive therapy as a feasible strategy. Biol Psychiatry. 2009;66:e11–2.

    PubMed  Google Scholar 

  125. Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2008;33:368–77.

    PubMed  Google Scholar 

  126. Morishita T, Fayad SM, Higuchi MA, Nestor KA, Foote KD. Deep brain stimulation for treatment-resistant depression: systematic review of clinical outcomes. Neurotherapeutics. 2014;11:475–84.

    CAS  PubMed  Google Scholar 

  127. Holtzheimer PE, Kelley ME, Gross RE, Filkowski MM, Garlow SJ, Barrocas A, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry. 2012;69:150–8.

    PubMed Central  PubMed  Google Scholar 

  128. Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45:651–60.

    CAS  PubMed  Google Scholar 

  129. Kayser S, Bewernick BH, Grubert C, Hadrysiewicz BL, Axmacher N, Schlaepfer TE. Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. J Psychiatr Res. 2011;45:569–76.

    PubMed  Google Scholar 

  130. Lisanby SH, Luber B, Schlaepfer TE, Sackeim HA. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology. 2003;28:1852–65.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Drs. Padberg, Palm, Brunoni, Ferrucci and Priori for kindly providing data on geriatric participants in their samples.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Verònica Gálvez, Kerrie-Anne Ho, Angelo Alonzo, Donel Martin and Duncan George declare that they have no conflict of interest.

Colleen K. Loo has received equipment support from Soterix for a clinical trial and funding from Australian NHRMC and Stanley medical research foundation for clinical trials of transcranial electrical stimulation.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia

    Verònica Gálvez, Kerrie-Anne Ho, Angelo Alonzo, Donel Martin, Duncan George & Colleen K. Loo

  2. Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia

    Verònica Gálvez, Kerrie-Anne Ho, Angelo Alonzo, Donel Martin, Duncan George & Colleen K. Loo

  3. Department of Psychiatry, St George Hospital, Level 2, James Laws House, Gray St, Kogarah, 2217, Sydney, NSW, Australia

    Colleen K. Loo

Authors
  1. Verònica Gálvez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerrie-Anne Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelo Alonzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donel Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Duncan George
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Colleen K. Loo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Colleen K. Loo.

Additional information

This article is part of the Topical Collection on Geriatric Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gálvez, V., Ho, KA., Alonzo, A. et al. Neuromodulation Therapies for Geriatric Depression. Curr Psychiatry Rep 17, 59 (2015). https://doi.org/10.1007/s11920-015-0592-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-015-0592-y

Keywords

Search

Navigation