Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls

Table 3 Uncontrolled studies exploring the effect of age on the antidepressant effect of transcranial magnetic stimulation by recruiting older subjects (mean age of sample > 60) or undertaking analyses in subgroups with mean age > 60

Trial	Age range	TMS parameters	Sample size	Methodology	Results
Figiel et al[37] 1998	60.0 (22-89)	10 Hz; 110%MT; left DLPFC; 500 pulses/session; 5 sessions; no. of pulses = 2500	50	Uncontrolled trial in patients > 18 yr attending a Mood Disorder Clinic (most referred for ECT)	Age associated with treatment response; < 65 (n = 28) responded better (56%) than > 65 group (n = 22; 23% response). Overall 42% responded after the 5 sessions
Nahas et al[38] 2004	61.2 (7.3)	5Hz; 103%-141%MT (distance adjusted); left DLPFC; 1600 pulses/session; 15 sessions; no. of pulses = 18000	18	Uncontrolled trial in patients 55-75 yr; not selected for TRD	No correlation between age and response; 27% responded; 22% remitted; No drop-outs due to adverse events
Fabre et al[35] 2004	67.9 (6.7)	10 Hz; 100%MT; left DLPFC; 1600 pulses/session; 10 sessions; no. of pulses = 16000	11	Uncontrolled trial in patients age > 55 with vascular depression (first episode) and TRD but kept antidepressant free for 1 wk	5 out of 11 patients had clinically meaningful improvement in HDRS scores; response inversely related to frontal volume. No drop-outs due to adverse events
Abraham et al[39] 2007	66.8 (6.4)	10 Hz; 100%MT; left DLPFC; 1600 pulses/session; 10 sessions; no. of pulses = 16000	20	Uncontrolled trial in patients > 60 yr attending a specialist clinic - most referred for ECT	30% responded at the end of treatment; 1 dropout due to discomfort
Milev et al[78] 2009	69.0 (6.7)	Variable parameters: LF (1 Hz, 1200 pulses/session, n = 14), HF (10 Hz, 1600 pulses/session n = 31); both LF and HF (n = 4); 80%-110%MT; right or left DLPFC	49	Uncontrolled trial that includes patients with TRD referred to 2 specialist mood disorder clinics; all except 3 medicated	24.7% mean reduction in HDRS scores; 18% responders; 1 dropout due to discomfort out of 49. (Note: This sample includes n = 20 from Abraham 2007)
Pallanti et al[33] 2012	51.8 (14.1)	1 Hz; 110%MT; right DLPFC; 420 pulses/session; 15 sessions.; no. of pulses = 6300	102	Uncontrolled trial in consecutively enrolled nonpsychotic subjects in a TMS clinic with TRD	Age inversely related to response especially in patients > 60 yr; overall 56.9% responded. 62.1% of < 60 (n = 66) and 47.2% of > 60 (n = 36) responded at 3 wk. 18.6% drop-outs due to intolerance
Hizli Sayar et al[36] 2013	66.6 (5.8)	25 Hz; 100%MT; left DLPFC; 1000 pulses/session; 18 sessions; no. of pulses = 18000	70	Uncontrolled trial in patients > 60 yr with TRD	58.5% responded; 29.2% remitted; No drop-outs due to adverse events
Ciobanu et al[34] 2013	58.7 (14.0)	LF (1 Hz, 1200 pulses/session, n = 80), HF (10 Hz, 2000 pulses/session n = 13); 90%MT; right or left DLPFC; 15 sessions; no. of pulses = 18000	93	Uncontrolled trial in > 18 yr old subjects with TRD	Age not related to response; No difference between < 65 (n = 63; 53.3% responded) and > 65 age (n = 30; 46.7% responded) groups immediately and at 3 mo

DLPFC: Dorsolateral Prefrontal Cortex; MT: Motor Threshold; RCT: Randomised Controlled Trial; ECT: Electroconvulsive therapy; TRD: Treatment resistant depression; TMS: Transcranial magnetic stimulation.