S046-003 Repetitive Transcranial Magnetic Stimulation and Quantitative EEG Analysis in Elderly and Younger Depressed Subjects
Gary Hasey, D MacCrimmon, M Criollo, G Abraham, S Lawson, K Saperson, A Pascual-Leone, and Russell J
This presentation is part of : Transcranial Magnetic Stimulation of the Elderly

Objective: The primary objective was to determine the efficacy of repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression in a geriatric compared with a younger population. A secondary objective was to determine whether the antidepressant response to rTMS is related to brain electrical activity as measured by quantitative electroencephalography (QEEG).
Design: Elderly depressed subjects were given open label rTMS as an adjunct to psychotropic medication. The antidepressant response was compared with that of 21 younger subjects receiving rTMS together with antidepressant medication. QEEG was done before the first and after the last rTMS session in all subjects.
Materials and methods: The elderly subjects (60 years of age or older) as well as the younger group (20-60 years of age, mean age = 44.9 years) met DSM IV criteria for major depressive disorder (MDD) or bipolar disorder (BD), depressed phase. All were considered treatment-resistant. The elderly were given either open label high (10 Hz) or low (1 Hz) frequency rTMS to the dorsolateral prefrontal cortex (DLPFC) as an adjunct to psychotropic medication. The antidepressant response was compared with that of 21 younger subjects recruited into a double blind sham-controlled trial where left high frequency rTMS to the left DLPFC was combined with a serotonin re-uptake inhibitor. The antidepressant response was determined objectively using the Hamilton depression rating scale and subjectively using the Beck depression rating scale and a visual analogue scale for depression. The relationship between QEEG alpha frequency power and change in depression rating scale scores were examined.
Results: Response, defined as 50% or greater decrease in depression severity, was seen in 30% of the elderly group, 18% of the younger group receiving true rTMS and 0% of the younger group receiving sham rTMS. Partial response, defined as 25 - 49% decrease in depression severity was seen in 20%, 36% and 60% of these groups respectively. The antidepressant response was related to the change in the ratio of left to right hemisphere alpha frequency power, when all subjects were analyzed together.
Conclusion: rTMS can be a safe and effective adjunct to antidepressants in patients with medication resistant depression. The antidepressant response and side effect profile in geriatric patients is similar to that of younger subjects. QEEG changes appear to be related to the antidepressant response.




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