The Efficacy and Safety of Neuromodulation Treatments in Late-Life Depression
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Geriatric Disorders (M Sajatovic and A Aftab, Section Editors)
The Efficacy and Safety of Neuromodulation Treatments in Late-Life Depression Sanne J. H. van Rooij, PhD1 Patricio Riva-Posse, MD1 William M. McDonald, MD1,2,* Address 1 Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA *,2 Brain Health Center, Fuqua Center for Late-Life Depression, 12 Executive Park Drive, NE, Floor 5, Atlanta, GA, 30329, USA Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Geriatric Disorders Keywords Geriatric depression I Late-life depression I Neuromodulation I Electroconvulsive therapy (ECT) I Transcranial magnetic stimulation (TMS) I Vagus nerve stimulation (VNS)
Abstract Purpose of Review In this review, the efficacy and safety of FDA-approved neuromodulation devices (electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS)), as well as emerging neuromodulation treatments currently under investigation. Recent Findings ECT is the “gold standard” somatic therapy for treatment-resistant depression (TRD). Although the clinical benefits are outweighed by potential cognitive and cardiovascular side effects in a majority of cases, it remains unfairly stigmatized. TMS has few cognitive or somatic side effects but is not as effective as the treatment of psychotic depression or more treatment-resistant depression in elders. VNS has limited data in older patients but has been shown to be effective in chronic, treatment-resistant adults. Several investigative neuromodulation treatments including magnetic seizure therapy (MST), focal electrically administered seizure therapy (FEAST), transcutaneous VNS (tVNS),
Geriatric Disorders (M Sajatovic and A Aftab, Section Editors) transcranial direct current stimulation (tDCS), and deep brain simulation (DBS) shown promise in geriatric TRD. Summary ECT, TMS, and VNS are effective treatments for late-life depression, and research has continued to refine the techniques. Investigative neuromodulation techniques are promising, but evidence for the safety and efficacy of these devices in the geriatric population is needed.
Introduction Approximately 7% of the US population over 60 years of age suffers from depression, and rates of treatment nonresponse to first-line pharmacotherapy and/or psychotherapy treatments are higher in older adults [1]. This heightened level of treatment non-response is possibly caused by age-related physiological changes that make geriatric patients more susceptible to antidepressant side effects and less likely to tolerate appropriate treatment dosage. Additionally, there is a higher likelihood of polypharmacy in older adults which increases risks for physical and cognitive impairments [2]. For many years,
electroconvulsive therapy (ECT) has been the “gold standard” treatment for geriatric depression, but there is cumulative evidence for other neuromodulation treatments for late-life mood disorders. In t
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