Conelea Christine A, Philip Noah S, Yip Agustin G, Barnes Jennifer L, Niedzwiecki Matthew J, Greenberg Benjamin D, Tyrka Audrey R, Carpenter Linda L
Bradley Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA.
J Affect Disord. 2017 Aug 1;217:42-47. doi: 10.1016/j.jad.2017.03.063. Epub 2017 Mar 29.
Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those <60 years in naturalistic clinical practice settings.
Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 <60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients.
Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05).
Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study.
Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.
重复经颅磁刺激（TMS）已被证明对普通成年人群中的难治性抑郁症（TRD）安全有效。与年轻患者相比，年龄较大（≥60岁）的患者存在更大的认知、身体和功能障碍负担，其疗效仍不明确。本研究旨在描述在自然临床实践环境中，≥60岁患者与<60岁患者相比，对急性TMS治疗疗程的抗抑郁反应。
回顾性收集并汇总了在两家门诊诊所接受急性门诊TMS治疗的TRD成年患者的数据（N = 231；≥60岁的患者n = 75，<60岁的患者n = 156）。在基线和急性治疗结束时进行自我报告抑郁量表评估。比较老年患者与年轻患者在连续测量指标和分类结局方面的变化。
两个年龄组的抑郁症状均有显著改善。两组之间的反应率和缓解率没有差异。在控制其他预测因素后，年龄组不是抑郁严重程度变化、临床反应或缓解的显著预测因素（所有p>.05）。
局限性包括依赖自我报告临床测量，以及由于研究的自然性质导致合并症和同时进行的药物治疗存在变异性。
结果表明，TMS治疗TRD的有效性不会因年龄而有差异地改变。基于这些自然数据，不应仅将年龄视为TMS抗抑郁疗效的禁忌证或不良预后指标。
