Is rTMS treatment effective for treatment-resistant depression?

A new study discovers that TMS treatment can be effective for treatment-resistant depression in older adults.

A new study discovers that rTMS treatment can be effective for treatment-resistant depression in older adults.

Research by Hinda and Arthur Marcus Institute for Aging Research and the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife is the first to discover an optimal repetitive Transcranial Magnetic Stimulation (rTMS) treatment plan for older adults with treatment-resistant depression.

TMS treatment uses magnetic fields to stimulate nerve cells in a specific part of the brain to successfully treat depression; the study revealed that treatment response is slower, and more sessions are required for older adults compared to younger individuals. As a result, this means that healthcare policies should be altered to suit the individual.

The new study is published in Frontiers in Ageing Neuroscience. 

What is treatment-resistant depression?

Treatment-resistant depression describes patients who have not responded to antidepressant treatments, however, there is a lack of universal guidelines addressing this area.

Treatment options for depression vary depending on how severe the condition is; doctors will recommend exercise, self-help, cognitive-behavioural therapy (CBT), counselling, and antidepressants.

If medication strategies outlined by healthcare professionals continue to offer no benefits, alternative options will be offered. Doctors may offer various therapies such as:

  • rTMS treatment which is typically delivered in 30-minute sessions;
  • Ketamine delivered through an IV in low doses;
  • Electroconvulsive therapy (ECT) where electricity triggers a small, brief seizure; or
  • Vagus nerve stimulation (VNA) which is typically only used when other therapies are unsuccessful.

Evaluating rTMS treatment

The new study followed over 500 patients and monitored their response to rTMS treatment in adults younger than 65 compared to adults over 65. The researchers found an initial slower response to treatment for older adults than younger adults, but after six weeks, the levels of improvement were similar in older and younger adults.

These new findings provide evidence that whilst older people may need more rTMS treatment sessions to improve depression severity, the effectiveness of rTMS treatment is clear, and offers a valuable option for treating this condition.

Alvaro Pascual-Leone, MD, PhD, Medical Director of the Deanna and Sidney Wolk Center for Memory Health and Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew Senior Life, is the lead author. “The findings are significant from a healthcare policy perspective because many major insurance providers in the US 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 options for major depression. It brings new hope to patients and their families that TMS can relieve treatment-resistant depression.”


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