Late-life depression (LLD) is a severe public health problem. Given that pharmacological treatments for LLD are limited by their side effects, development of efficient and tolerable nonpharmacological treatment for LLD is urgently required. This study investigated whether high-frequency external muscle stimulation could reduce depressive symptoms in LLD.
Methods:
Twenty-two older male veterans with major depression were recruited and randomized into a treatment (n = 9) or sham control group (n = 13). The groups received high-frequency external muscle stimulation or sham intervention 3 times per week for 12 weeks. Clinical symptoms and muscle strength were evaluated at baseline and every 2 weeks.
Results:
The 2 groups were homogeneous in age, baseline clinical symptoms, and muscle strength. The treatment group showed significant improvement in depression and anxiety scores and muscle strength (all P < .01), whereas the control group showed no significant change after the 12-week follow-up. Compared to the control group, the treatment group showed significant improvements in depression (Geriatric Depression Scale, P = .009; Hamilton Depression Rating Scale, P = .007) and anxiety scores (HAMA, P = .008) and muscle strength (all P < .001). Changes in depression and anxiety levels were significantly correlated with changes in muscle strength after the study. In the treatment group, we observed a trend of correlation between the reduction in depression and muscle strength gains.
Conclusion:
High-frequency external muscle stimulation appears to be an effective treatment for older patients with LLD. Large studies with more tests and/or conducted in different populations are warranted to validate these preliminary findings.
BlazerDG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249–265.
2.
BellaRPennisiGCantoneHM, et al.Clinical presentation and outcome of geriatric depression in subcortical ischemic vascular disease. Gerontology. 2010;56(3):298–302.
3.
ConcertoCLanzaGCantoneM, et al.Different patterns of cortical excitability in major depression and vascular depression: a transcranial magnetic stimulation study. BMC Psychiatry. 2013;13:300.
4.
ConcertoCLanzaGCantoneM, et al.Repetitive transcranial magnetic stimulation in patients with drug-resistant major depression: A six-month clinical follow-up study. Int J Psychiatry Clin Pract. 2015;19(4):252–258.
5.
PennisiMLanzaGCantoneM, et al.Correlation between motor cortex excitability changes and cognitive impairment in vascular depression: pathophysiological insights from a longitudinal TMS study. Neural Plast. 2016. 2016:8154969.
6.
SeitzDPGillSSConnDK. Citalopram versus other antidepressants for late-life depression: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2010;25(12):1296–1305.
7.
LeeMRJungSMBangHKimHSKimYB. The association between muscular strength and depression in Korean adults: a cross-sectional analysis of the sixth Korea national health and nutrition examination survey (KNHANES VI) 2014. BMC Public Health. 2018;18(1):1123.
8.
BrownPJBadreddineDRooseSP, et al.Muscle fatigability and depressive symptoms in later life. Int J Geriatr Psychiatry. 2017;32(12):e166–e172.
YeungSReijnierseMETrappenburgCMBlauwJG. Knee extension strength measurements should be considered as part of the comprehensive geriatric assessment. BMC Geriatr. 2018;18(1):130.
11.
HeoJEShimJSSongBM, et al.Association between appendicular skeletal muscle mass and depressive symptoms: review of the cardiovascular and metabolic diseases etiology research center cohort. J Affect Disord. 2018;238:8–15.
12.
FukumoriNYamamotoYTakegamiM, et al.Association between hand-grip strength and depressive symptoms: locomotive syndrome and health outcomes in Aizu cohort study (LOHAS). Age Ageing. 2015;44(4):592–598.
13.
LinoVTRodriguesNCO’DwyerG, et al.Handgrip strength and factors associated in poor elderly assisted at a primary care unit in Rio de Janeiro, Brazil. PLoS One. 2016;11(11):e0166373.
14.
CantoneMBramantiALanzaG, et al.Cortical plasticity in depression. ASN Neuro. 2017;9(3):1759091417711512.
15.
SpampinatoCAgugliaEConcertoC, et al.Transcranial magnetic stimulation in the assessment of motor cortex excitability and treatment of drug-resistant major depression. IEEE Trans Neural Syst Rehabil Eng. 2013;21(3):391–403.
16.
BordetRIhlRKorczynAD, et al.Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report. BMC Med. 2017;15(1):107.
17.
SanchezBRPuchePPGonzález-BadilloJJ. Percutaneous electrical stimulation in strength training: an update. J Strength Cond Res. 2005;19(2):438–448.
18.
BaxLStaesFVerhagenA. Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med. 2005;35(3):191–212.
19.
HeidlandAFazeliGKlassenA, et al.Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting. Clin Nephrol. 2013;79(Suppl 1):S12–S23.
20.
HainautKDuchateauJ. Neuromuscular electrical stimulation and voluntary exercise. Sports Med. 1992;14(2):100–113.
21.
ReichsteinLLabrenzSZieglerDMartinS. Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. Diabetologia. 2005;48(5):824–828.
22.
MignardotJBDeschampsTLe GoffCG, et al.Neuromuscular electrical stimulation leads to physiological gains enhancing postural balance in the pre-frail elderly. Physiol Rep. 2015;3(7):pii e12471.
23.
Oliveira MeloMDAragaoFAVazMA. Neuromuscular electrical stimulation for muscle strengthening in elderly with knee osteoarthritis—a systematic review. Complement Ther Clin Pract. 2013;19(1):27–31.
24.
SillenMJHSpeksnijderCMEtermanRA, et al.Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature. Chest. 2009;136(1):44–61.
25.
KaratzanosEGerovasiliVZervakisD, et al.Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Crit Care Res Pract. 2012;2012:432752.
26.
HumpertPMMorcosMOikonomouD, et al.External electric muscle stimulation improves burning sensations and sleeping disturbances in patients with type 2 diabetes and symptomatic neuropathy. Pain Med. 2009;10(2):413–439.
27.
ChangTYChuehKH. Relationship between elderly depression and health status in male veterans. J Nurs Res. 2011;19(4):298–304.
28.
BockJOHajekAWeyererS, et al.The impact of depressive symptoms on healthcare costs in late life: longitudinal findings from the AgeMoode study. Am J Geriatr Psychiatry. 2017;25(2):131–141.
29.
HamiltonM. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
30.
MaierWBullerRPhilippMHeuserI. The Hamilton anxiety scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord. 1988;14(1):61–68.
31.
RussellDPeplauLACutronaCE. The revised UCLA loneliness scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980;39(3):472–480.
32.
FlorenceJMPandyaSKingWM, et al.Intrarater reliability of manual muscle test (Medical Research Council scale) grades in Duchenne’s muscular dystrophy. Phys Ther. 1992;72(2):115–122;discussion 122-6.
33.
KendallFPMcCrearyEKProvancePG. Muscles: Testing and Function with Posture and Pain. 5th ed. Baltimore, MD: LWW; 2005.
34.
AversDBrownM. Daniels and Worthingham’s Muscle Testing: Techniques of Manual Examination. 10th ed. Philadelphia, PA: Saunders; 2018.
35.
PennETracyDK. The drugs don’t work? Antidepressants and the current and future pharmacological management of depression. Ther Adv Psychopharmacol. 2012;2(5):179–188.
36.
SansoneRASansoneLA. Antidepressant adherence: are patients taking their medications?Innov Clin Neurosci. 2012;9(5-6):41–46.
37.
WilliamsKJBabberARavikumarRDaviesAH. Non-invasive management of peripheral arterial disease. Adv Exp Med Biol. 2017;906:387–406.
38.
ZhangYChenYMaL. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci. 2018;47:1–5.
39.
KangDHJeonJKLeeJH. Effects of low-frequency electrical stimulation on cumulative fatigue and muscle tone of the erector spinae. J Phys Ther Sci. 2015;27(1):105–108.
40.
LangeardABigotLChastanNGauthierA. Does neuromuscular electrical stimulation training of the lower limb have functional effects on the elderly? A systematic review. Exp Gerontol. 2017;91:88–98.
41.
LuijpenMWSwaabDFSergeantJASergeantEJA. Effects of transcutaneous electrical nerve stimulation (TENS) on self-efficacy and mood in elderly with mild cognitive impairment. Neurorehabil Neural Repair. 2004;18(3):166–175.
42.
BrownPJRutherfordBRYaffeK, et al.The depressed frail phenotype: the clinical manifestation of increased biological aging. Am J Geriatr Psychiatry. 2016;24(11):1084–1094.
43.
KaravidasAIRaisakisKGParissisJD, et al.Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2006;13(4):592–597.
44.
JacobsMJJörningPJJoshiSRKitslaarPJSlaafDWRenemanRS. Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischemia. Ann Surg. 1988;207(2):179–183.
45.
BakerLLChambersRDeMuthSKVillarF. Effects of electrical stimulation on wound healing in patients with diabetic ulcers. Diabetes Care. 1997;20(3):405–412.
46.
PimentaADSLambertucciRHGorjãoRSilveiraLDRCuriR. Effect of a single session of electrical stimulation on activity and expression of citrate synthase and antioxidant enzymes in rat soleus muscle. Eur J Appl Physiol. 2007;102(1):119–126.
47.
GondinJBroccaLBellinzonaE, et al.Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol (1985). 2011;110(2):433–450.
48.
van AgtmaalMJMHoubenAJHMPouwerF, et al.Association of microvascular dysfunction with late-life depression: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(7):729–739.
49.
AlexopoulosGSMorimotoSS. The inflammation hypothesis in geriatric depression. Int J Geriatr Psychiatry. 2011;26(11):1109–1118.
50.
CollinsDFBurkeDGandeviaSC, Sustained contractions produced by plateau-like behaviour in human motoneurones. J Physiol. 2002;538(Pt 1):289–301.
51.
ChipchaseLSSchabrunSMHodgesPW. Peripheral electrical stimulation to induce cortical plasticity: a systematic review of stimulus parameters. Clin Neurophysiol. 2011;122(3):456–463.
52.
MangCSLagerquistOCollinsDF. Changes in corticospinal excitability evoked by common peroneal nerve stimulation depend on stimulation frequency. Exp Brain Res. 2010;203(1):11–20.
53.
MiyataKUsudaS. Changes in corticospinal excitability with short-duration high-frequency electrical muscle stimulation: a transcranial magnetic stimulation study. J Phys Ther Sci. 2015;27(7):2117–2120.
ShibasakiWMMartinsRP. Simple randomization may lead to unequal group sizes. Is that a problem?Am J Orthod Dentofacial Orthop. 2018;154(4):600–605.
56.
LachinJM. Properties of simple randomization in clinical trials. Control Clin Trials. 1988;9(4):312–326.
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