For older adults with treatment-resistant depression, rTMS may work

New research has found that repetitive transcranial magnetic stimulation (rTMS) can be an effective treatment for older adults struggling with persistent depression, but its response time just may be slower than experienced in younger adults.

The study, published in the journal, Frontiers in Aging Neuroscience, was led by scientists at Hinda and Arthur Marcus Institute for Aging Research and the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife in Boston, Massachusetts.

A noninvasive procedure, rTMS uses magnetic fields to stimulate nerve cells in a specific part of the brain to address depression, but the study found the treatment response can be slower and take a larger number of rTMS treatment sessions in older adults than with younger individuals. Brain stimulation strategies, and specifically rTMS, have been considered an effective antidepressant treatment for those who do not respond or tolerate other treatment strategies but other studies suggested that rTMS was less effective in older adults.

Researchers evaluated the rTMS treatment outcomes in a large international multicenter cohort of more than 546 patients and compared the response to rTMS in adults younger than 65 to those older than 65. Researchers found there is an initial slower response to treatment for older adults than younger adults but that after six weeks, the degree of improvement in older and younger adults is the same.

Therefore, the new study provides experimental evidence that while more sessions may be needed in older adult patients to improve depression severity, rTMS offers a valuable therapeutic option.

“The findings are significant from a healthcare policy perspective because many major insurance providers in the U.S. have coverage policies that hinge on a clinical response within four weeks. They need to expand coverage to at least beyond six weeks of treatment to ensure maximal benefit for older adults who are in particular need of effective treatment option for major depression,” said Alvaro Pascual-Leone, MD, PhD, medical director of the Deanna and Sidney Wolk Center for Memory Health and lead author of the study in a statement. “It brings new hope to patients and their families that TMS can relieve treatment-resistant depression.”