Efficacy,Tolerability and Safety of Transcranial Magnetic Stimulation in Geriatric Depression: A State-of-the-Art Review

Abstract

Background

With population ageing, addressing geriatric depression (GD) often underdiagnosed and inadequately treated is critical. This comprehensive review examines the efficacy, tolerability and safety of different transcranial magnetic stimulation (TMS) techniques for treating GD.

Methods

A literature review was conducted, focusing on different TMS modalities such as repetitive TMS (rTMS), theta burst stimulation (TBS), deep TMS (d-TMS), high frequency rTMS, and their application in older adults with depression.

Results

The efficacy of standard rTMS for GD showed mixed results, while non-conventional d-TMS demonstrated higher response and remission rates due to its ability to stimulate deeper and broader brain regions. TBS was noted for its shorter treatment durations and potential to enhance neuroplasticity, although effectiveness was highly dependent on the brain target. High-frequency rTMS and priming protocols suggested possible improvements in treatment outcomes. TMS was found to be safe and well-tolerated, with mostly mild and transient adverse effects in older adults.

Conclusions

Larger, placebo-controlled trials with standardized protocols are necessary to refine TMS techniques for GD, considering factors like brain atrophy, targeting precision, and treatment dosing. This review highlights TMS as a promising alternative to conventional treatments, warranting further research to optimize its clinical efficacy for GD.