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

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.