Department of Old Age Psychiatry, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.
Department of Neurology, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, Netherlands.
Int J Geriatr Psychiatry. 2021 Mar;36(3):383-392. doi: 10.1002/gps.5440. Epub 2020 Nov 6.
In the last decade, repetitive transcranial magnetic stimulation (rTMS) has been introduced as a non-invasive neuromodulation therapy for depression. Little is known, however, about (serious) adverse events (AE) of rTMS in older adults with a depression. In this article, we want to study what is known about (serious) AE of rTMS in older adults (>60 years) with late-life depression (LLD).
A systematic search has been performed according to the PRISMA guidelines in PubMed, EMBase and PsycInfo. We have screened 622 articles for eligibility. Eleven studies, evaluating 353 patients in total, were included in this review.
AE were reported in 12.4% of the older adults with a LLD treated with rTMS, serious AE in 1.5%. Headache (6.9%) and discomfort at the stimulation site (2.7%) are the most commonly reported AE. Serious AE reported are: psychiatric hospitalization (three times), a combination of posterior vitreous detachment and retinal tear, and increased suicide ideation (both once).
rTMS in older adults with LLD was concluded overall to be safe due to the low frequency of AE reported in trials and observational studies. In case-reports, however, more serious AE have been described. To tailor use of rTMS in older adults with LLD, more research is needed in larger samples to optimize tolerance.
在过去的十年中，重复经颅磁刺激（rTMS）已被引入作为一种非侵入性的神经调节疗法，用于治疗抑郁症。然而，对于老年抑郁症患者接受 rTMS 治疗时的（严重）不良事件（AE）知之甚少。在本文中，我们旨在研究老年（>60 岁）晚发性抑郁症（LLD）患者接受 rTMS 治疗时的（严重）AE 情况。
根据 PRISMA 指南，我们在 PubMed、EMBase 和 PsycInfo 中进行了系统搜索。我们对 622 篇文章进行了筛选，以确定其是否符合纳入标准。共有 11 项研究，共纳入 353 例患者，纳入了本综述。
12.4%的接受 rTMS 治疗的老年 LLD 患者报告了 AE，1.5%的患者报告了严重 AE。头痛（6.9%）和刺激部位不适（2.7%）是最常见的 AE。报告的严重 AE 包括：精神病住院（3 次）、后玻璃体脱离伴视网膜撕裂、自杀意念增加（各 1 次）。
由于试验和观察性研究报告的 AE 频率较低，总体而言，rTMS 治疗老年 LLD 是安全的。然而，在病例报告中，描述了更多的严重 AE。为了在老年 LLD 患者中合理使用 rTMS，需要在更大的样本中进行更多的研究，以优化耐受性。
