Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55-75 years of age: a pilot study
Open accessAbstract
In contrast to the effects seen in younger adults, depressed elderly subjects have shown more modest antidepressant responses to transcranial magnetic stimulation (TMS). We theorized that higher stimulation intensities in older depressed subjects with prefrontal atrophy might be needed to stimulate underlying cortex. In an open design with patients on stable baseline medications, we treated 18 treatment-resistant elderly depressed subjects (mean age 61.2 +/- 7.3) with 15 rTMS sessions over 3 weeks. We adjusted the delivered TMS intensity to account for MRI measured prefrontal atrophy. The skull to prefrontal cortex distance increased with age, whereas the skull to motor cortex distance did not. All subjects tolerated the higher doses well. The average intensity used was 114% of motor threshold (MT) with a range from 103-141% MT. There was an average 35% decline over the 3 weeks in HRSD scores. After 3 weeks of treatment, 27% (5/18) met response criteria (> 50% improvement), with four of these five also meeting criteria for remission (exit Hamilton Depression Score < 8). These initial pilot findings support the need for blinded studies using prefrontal TMS in an elderly population, testing whether TMS, delivered at stimulation intensities calculated to overcome atrophy, is more effective than TMS without adjusting for atrophy.
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Previous work has suggested that older adults require higher stimulation intensities to ensure sufficient cortical stimulation.
“Previous work has suggested that older adults require higher stimulation intensities39 to ensure sufficient cortical stimulation.”
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- Authors
- Nahas, Z., Li, X., Kozel, F. A., Mirzki, D., Memon, M., Miller, K., Yamanaka, K., Anderson, B., Chae, J.-H., Bohning, D. E., Mintzer, J., & George, M. S.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Nahas, Ziad
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2004
- Volume
- 19
- Issue
- 4
- Pages
- 249-256
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2030059679
- Cited by
- 145
- References
- 48
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 8 · 2023: 10 · 2022: 8 · 2021: 4 · 2020: 7 · 2019: 6 · 2018: 4 · 2017: 9 · 2016: 10 · 2015: 10 · 2014: 3 · 2013: 5 · 2012: 8
- FWCI
- 4.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical University of South Carolina
- National Alliance for Research on Schizophrenia and Depression
- National Institutes of Health (5r01ns040956-03, 5r01rr014080-02)
- National Institute of Mental Health (R01 RR14080-01)
- National Institute of Neurological Disorders and Stroke (R01 NS40956-1)
- National Center for Research Resources (R01 RR14080-01)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- repetitive transcranial magnetic stimulation, prefrontal cortex, geriatric depression, treatment-resistant depression, motor threshold, antidepressant response, remission, tolerability
- MeSH terms
- Aged, Atrophy, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Surveys and Questionnaires, Severity of Illness Index, Skull, Prefrontal Cortex, Diagnostic and Statistical Manual of Mental Disorders, Transcranial Magnetic Stimulation
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