By Dr. David Woo - October 3, 2022

While depression is not a normal part of aging, adults aged 65 and older have an increased risk of developing depression. What’s more, is that treating late-life depression is challenging, and studies show that antidepressants aren’t as effective in older patients as they are in younger ones.(1)

Treatment resistance is the term used when patients don’t respond to or see enough symptom relief from traditional treatments, like antidepressants and psychotherapy. When treatment resistance occurs in older adults, it’s referred to as treatment-resistant late-life depression or treatment-resistant geriatric depression.

While treatment resistance can be frustrating, older adults with depression still have hope. Newer research tells us that a medication-free treatment, called transcranial magnetic stimulation or TMS, is effective in relieving depression symptoms of treatment-resistant late-life depression. 

What Is TMS?

Transcranial magnetic stimulation, generally referred to as just TMS, is a safe outpatient procedure that is proven to reduce symptoms of depression, anxiety, and a growing list of other mental health conditions. TMS therapy uses an electromagnetic coil that safely sends magnetic pulses to a targeted area of the brain. These magnetic pulses create an electric field that stimulates the brain and moderates brain activity to help relieve symptoms of depression.(2)

As opposed to antidepressants that chemically stimulate the brain, TMS uses electrical properties to relieve symptoms of depression, and is uniquely effective at treating individuals that have not experienced relief from prescription medications.(3)

Research Suggests that TMS Is Safe and Effective for Geriatric Patients with Depression

Extensive studies have shown TMS to be a safe and well-tolerated therapy with few, mild, and rare incidence of side effects.(4) While the majority of studies on TMS have mostly been conducted with non-elderly participants, researchers confirm that there is no evidence to suggest that TMS cannot be safely practiced on geriatric patients, nor that elderly patients are more at risk of side effects.(5)

In clinical trials using TMS to treat symptoms of depression in elderly patients, researchers have found TMS treatment can significantly improve remission rates of geriatric depressive symptoms. According to studies, elderly patients who received TMS therapy experienced no serious complications and TMS had no negative effect on executive function.(6)

TMS Has Special Significance to the Elderly

One of the major challenges of treating geriatric depression is that there are limited ideal depression treatment options for this population. Access to psychotherapy is limited to cost and availability. While prescription medications have proven to be effective at reducing symptoms of depression, they often have extensive and sometimes severe physical and cognitive side effects. Electroconvulsive therapy (ECT) is a treatment shown to be effective for many, however, the physical tolerability of ECT makes elderly patients poor candidates for treatment.(6)

TMS is therefore a unique therapy option that can be well-tolerated and effective for use with elderly patients suffering from late-life depression symptoms.

In addition to depression, preliminary studies show that TMS is also safe and effective in applications especially relevant to elderly individuals–patients looking to improve cognitive impairment, find relief from neuropathic pain, and quit smoking.(7)

Learn More about TMS and Other Treatments for Geriatric Depression

If you or a loved one are experiencing symptoms of late-life depression, contact us today to learn more about available treatment options. Schedule an appointment with us online or call 212.731.2033.

Resources:

1. Knöchel C, Alves G, Friedrichs B, Schneider B, Schmidt-Rechau A, Wenzler S, Schneider A, Prvulovic D, Carvalho AF, Oertel-Knöchel V. Treatment-resistant Late-life Depression: Challenges and Perspectives. Curr Neuropharmacol. 2015;13(5):577-91. Link. Accessed September 14, 2022.

2. Transcranial Magnetic Stimulation. MayoClinic. Published November 27, 2018. Link. Accessed September 9, 2022.

3. Somani A, Kar SK. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr. 2019;32(4):e100074. Link. Accessed September 9, 2022.

4. Rossi S, Hallett M, Rossini PM, Pascual-Leone A; Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008-2039. Link. Accessed September 9, 2022.

5. Sabesan P, Lankappa S, Khalifa N, Krishnan V, Gandhi R, Palaniyappan L. Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls. World J Psychiatry. 2015;5(2):170-181. Link. Accessed September 9, 2022.

6. Kaster TS, Daskalakis ZJ, Noda Y, et al. Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial. Neuropsychopharmacology. 2018;43(11):2231-2238. Link. Accessed September 9, 2022.7. Iriarte IG, George MS. Transcranial Magnetic Stimulation (TMS) in the Elderly. Curr Psychiatry Rep. 2018;20(1):6. Published 2018 Feb 10. https://pubmed.ncbi.nlm.nih.gov/29427050/. Accessed September 9, 2022.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.