Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls

Table 2 Randomised Controlled Trials investigating antidepressant effect of transcranial magnetic stimulation in older subjects (mean age of sample > 60)

Trial	Age range	TMS parameters	Sample size	Methodology	Results
Manes et al[30] 2001	60.7 ± 9.8	20 Hz; 80%MT; left DLPFC; 800 pulses/session; 5 sessions; no. of pulses = 4000	20 (sham = 10)	Double blind RCT with handle as sham in subjects with one antidepressant failure aged 50-70, withdrawn from antidepressants for 5 d	No sham vs active differences; in each group 30% responded. Non-responders had reduced frontal volume. No drop-outs due to adverse effects
Mosimann et al[31] 2004	62 + 12	20 Hz; 100%MT; left DLPFC; 1600 pulses/session; 10 sessions; no. of pulses = 16000	24 (sham = 9)	Double blind RCT with tilted-sham in 40-90 years old subjects with TRD	No sham vs active differences
Jorge et al[32] 2008 (Trial 1)	62.9 (7.2)	10 Hz; 110%MT; MRI-based target localisation of left DLPFC; 1200 pulses/session; 10 sessions; no. of pulses = 12000	30 (sham = 15)	Double blind RCT with look-alike sham coil in subjects > 50 yr age with vascular depression and failed at least one antidepressant; all patients medication-free for at least 4 d before TMS	Age inversely correlated with response; frontal volume positively correlated with response. Active treatment: 33.3% responders; sham: 6.7% responders. No drop-outs due to adverse events
Jorge et al[32] 2008 (Trial 2)	64.3 (9.4)	10 Hz; 110%MT; MRI-based target localisation of left DLPFC; 1200 pulses/session; 15 sessions; no. of pulses = 18000	62 (sham = 29)	Double blind RCT with look-alike sham coil in subjects > 50 yr age with vascular depression and failed at least one antidepressant; all patients medication-free for at least 4 d before TMS	Active treatment: 39.4% responders; sham: 6.9% responders. Older subjects had better response for higher dose. No drop-outs due to adverse events

DLPFC: Dorsolateral Prefrontal Cortex; MT: Motor Threshold; RCT: Randomised Controlled Trial; TMS: Transcranial magnetic stimulation.