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Repetitive Transcranial Magnetic Stimulation for Treatment of Medication-Resistant Depression in Older Adults: A Case Series

Milev, Roumen MD, PhD, FRCPsych(UK), FRCP(C)*; Abraham, Gaby MD, FRCP(C); Hasey, Gary MD, FRCP(C); Cabaj, Jason Lee§

doi: 10.1097/YCT.0b013e3181770237
Original Studies

The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) are well documented, but studies to date have produced heterogeneous results in late-life depression.

Objective: To address this matter, we evaluated the efficacy of both high- and low-frequency rTMS delivered to the prefrontal cortex of older adults with treatment-resistant major depression.

Methods: Forty-nine older adults (69 ± 6.7 years) with treatment-refractory major depressive disorders underwent a series of rTMS treatments as an adjuvant to pharmacotherapy. Patients received high-frequency rTMS delivered to the left dorsolateral prefrontal cortex, low-frequency stimulation to the right dorsolateral prefrontal cortex, or a combination thereof, at 80-110% of the motor threshold.

Results: There was a modest, but statistically significant, mean reduction (24.7%) in Hamilton Depression Rating Scale (HDRS) scores from baseline to the end of treatment. Nine patients were classified as responders (50% HDRS reduction), and 4 patients reached remission status (final HDRS score <8). Similar improvements in HDRS scores were observed for high- and low-frequency rTMS. Treatment was generally well tolerated, and no serious adverse effects were reported.

Conclusions: The findings support the contention that in older adults with treatment-refractory depression, rTMS can be an effective treatment alternative for some patients.

From the *Department of Psychiatry, Queen's University, Kingston; †Department of Psychiatry, University of Toronto, Toronto; ‡Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton; and §Queen's University, Kingston, ON, Canada.

Received for publication January 4, 2008; accepted March 20, 2008.

Reprints: Roumen Milev, MD, PhD, FRCPsych(UK), FRCP(C), Department of Psychiatry, Queen's University, c/o Providence Care, MHS, 752 King Street West, Kingston, ON, Canada K7L 4X3 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.