‘A sound mind in a sound body’ is the English translation of a famous quotation by the Greek philosopher Thales. This concept is of especial importance in the elderly. Physical disorders that increase with age can induce depression, and, conversely, late-life depression can increase the risk of certain physical disorders, as well as the risk of death from illness. At the same time, depression reduces an elderly person’s ability to rehabilitate. The emotional distress associated with depression can have a huge impact on the physical and functional fitness of the elderly.
Depression is common among the elderly, but is by no means a normal part of aging. Depressive symptoms are experienced by as many as 20% of non-institutionalized older adults, with even higher rates among the elderly in hospitals and in long-term care facilities. But despite its prevalence, late-life depression is often underdiagnosed, both in primary care settings and in care facilities. Depressive symptoms are frequently overlooked and attributed to other medical illnesses or life circumstances that commonly occur as people age. The stigma surrounding mental illness and is treatment is more pronounced among the elderly, who are least likely to seek help from a health professional when struggling with depression.
Treating Geriatric Depression
But even when depression is acknowledged and properly diagnosed, it can be complicated to treat. Although the effectiveness of antidepressant medications is not substantially affected by age, treatment is hampered by intolerance due to side effects or interactions with other medications. Side effects such as sedation or sudden rises in blood pressure can lead to falls and fractures, which can be especially devastating in the elderly. Moreover, in severe cased of depression in which basic daily functioning is compromised, medications are simply not enough.
Repetitive transcranial magnetic stimulation (rTMS) has an excellent safety profile and is well-tolerated, yet older age is correlated with poor response. TMS studies in elderly populations are few, and they have yielded response rates on the order of 30% or less. Antidepressant efficacy of TMS is correlated with higher stimulation intensity and higher frontal gray matter volume. Prefrontal atrophy at old age increases the distance between the skull and cortex, and may account for the low responsiveness of geriatric depression patients.
Deep TMS Geriatric Depression Clinical Trial
Brainsway® recently concluded a clinical trial of its Deep TMS device in an elderly population of major depression patients. Our researchers posited that the deeper stimulation afforded by the H-coil might overcome the increased scalp-to-cortex distance and thus improve treatment efficacy. The results show that Brainsway Deep TMS is safe for treating these patients, and has significant beneficial effects on depressive symptoms. No significant side effects were reported.
The study was held in Shalvata Medical Center in Hod Hasharon, Israel, headed by Dr Dafna Shefet. The trial included 14 patients aged 64 or older (with a mean age of 72.4), with a diagnosis of MDD and a history of treatment-resistance. The patients received 20 Deep TMS treatments over 4 weeks, using the FDA-approved protocol for depression.
The results showed a significant average improvement of 5.07 points in the HDRS (Hamilton Rating Scale for Depression) rating, which measures the depressive level, and a significant improvement of 5.29 points in the HARS scale (Hamilton Anxiety Rating Scale), measuring the anxiety level, after 4 weeks of treatment.
Furthermore, statistical results from several U.S. clinics that treat depression patients using Brainsway Deep TMS show that out of 27 patients suffering from geriatric depression, 12 patients (44%) reached remission, and 17 patients (63%) reached a significant response after 20 treatments. The impact of the treatment was measured using the PHQ-9 questionnaire, a standard depression rating scale.