Repetitive transcranial magnetic stimulation: an effective treatment for resistant depressive episodes in the elderly

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Objectives To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in older (≥60 years) versus younger (<60 years) patients with treatment-resistant depression (TRD), and to determine whether age affects clinical outcomes in a naturalistic clinical setting.Method A retrospective analysis was conducted on 272 patients with TRD treated with rTMS at a tertiary psychiatric hospital. Depression severity was assessed at baseline, end-of-treatment (V1), and one-month follow-up (V2) using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI). Response (≥50% MADRS reduction) and remission (MADRS ≤10) rates were calculated. Repeated measures ANOVA and logistic regression were used to examine the influence of age and treatment protocol.Results Both age groups showed significant improvement in depressive symptoms. Older adults had higher remission rates at V1 (36% vs. 23%, p = 0.033), although this difference was no longer significant at V2. No interaction between age and protocol was observed. Female sex was the only significant predictor of remission at V2 (OR = 14.25, p = 0.021). Sensitivity analyses treating age as a continuous variable yielded consistent findings.Conclusion rTMS is an effective treatment for TRD in both older and younger adults. Older patients respond comparably to younger ones, challenging concerns about age-related reductions in neuromodulation efficacy. These findings support the use of rTMS in late-life depression without major protocol adjustments and underscore the need for future studies examining personalized treatment parameters and psychosocial moderators of response.

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