Real-World Effectiveness and Tolerability of Prolonged Intermittent Theta Burst Stimulation in Older Adults With Treatment-Resistant Depression

IF 2.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-06-12 DOI:10.1002/gps.70111

Chih-Ming Cheng, Jia-Shyun Jeng, Mu-Hong Chen, Wen-Han Chang, Mu-N Liu, Wei-Chen Lin, Shih-Jen Tsai, Ya-Mei Bai, Tung-Ping Su, Cheng-Ta Li

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引用次数: 0

Abstract

Background

Older treatment-resistant depression (TRD) patients with transportation concerns may struggle to complete 30–36 repetitive transcranial magnetic stimulation (rTMS) sessions. Uninsured rTMS medical costs may be another issue in certain nations. 2-Week prolonged intermittent theta-burst stimulation (iTBS1800) to the left-sided dorsolateral prefrontal cortex (DLPFC) demonstrated similar antidepressant efficacy to standard rTMS or iTBS in adults with TRD. However, no study has yet confirmed the antidepressant effect of iTBS1800 in geriatric TRD patients.

Methods

We analyzed chart data from May 2018 to September 2022 to identify TRD patients aged ≥ 50 years who received self-pay TMS treatments at a single medical center in Taiwan. All patients had major depressive disorder and had failed at least one prior antidepressant treatment. The Hamilton Depression Rating Scale (HDRS-17) was evaluated before and after TMS stimulation.

Results

97 older patients with TRD (mean ± SD, age, 62.81 ± 7.89; 69.1%% female) was identified. Approximately 70% of patients reported anxious depression and prior antidepressant failures (≥ 3). The average number of self-pay TMS sessions was 11.71 ± 3.15) (range:10–30). Patients receiving iTBS1800 demonstrated a greatly higher remission rate than those receiving 10 Hz rTMS (29.5% vs 13.2%, respectively, p = 0.048), particularly in patients with mild and moderate depression. Age was not a clinically significant determinant of remission following TMS therapy.

Conclusion

Left-sided DLPFC iTBS1800 may be a feasible option for treating older patients with TRD due to its favorable effect and shorter treatment period, which may be ideal for patients with transportation, budgetary and vacation restrictions. More study is needed to compare the antidepressant efficacy of iTBS1800 to other TMS protocols in older patients with TRD.

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延长间歇性θ波爆发刺激在老年难治性抑郁症患者中的实际疗效和耐受性

有交通问题的老年难治性抑郁症（TRD）患者可能难以完成30-36个重复经颅磁刺激（rTMS）疗程。在某些国家，未投保的rTMS医疗费用可能是另一个问题。在成人TRD患者中，对左侧背外侧前额叶皮层（DLPFC）进行2周延长的间歇性theta-burst刺激（iTBS1800）显示出与标准rTMS或iTBS相似的抗抑郁效果。然而，尚无研究证实iTBS1800对老年TRD患者的抗抑郁作用。方法分析2018年5月至2022年9月的图表数据，以确定在台湾单一医疗中心接受自费经颅磁刺激治疗的年龄≥50岁的TRD患者。所有患者均患有重度抑郁症，且既往至少有一次抗抑郁药物治疗失败。在经颅磁刺激前后分别评估汉密尔顿抑郁评定量表（HDRS-17）。结果老年TRD患者97例(平均±SD，年龄62.81±7.89；69.1%为女性)。大约70%的患者报告焦虑性抑郁和既往抗抑郁失败（≥3）。平均自费TMS次数为11.71±3.15次（范围：10 ~ 30次）。接受iTBS1800治疗的患者的缓解率大大高于接受10 Hz rTMS治疗的患者（分别为29.5% vs 13.2%, p = 0.048），特别是在轻度和中度抑郁症患者中。年龄不是经颅磁刺激治疗后缓解的临床显著决定因素。结论左侧DLPFC iTBS1800治疗老年TRD效果好，治疗时间短，适合交通、预算、假期受限的患者，是治疗老年TRD的可行选择。iTBS1800与其他经颅磁刺激方案在老年TRD患者中的抗抑郁疗效比较需要更多的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.