Neuromodulation Therapies in the Elderly Depressed Patient

Depression in the elderly is a serious condition, and if not treated effectively, it can increase morbidity and mortality. In addition, it is associated with cognitive impairment and multiple medical problems. Frailty is also associated with depression. Depression in this age group can easily become resistant to the usual treatment, even with adequate medication and or psychotherapy, and it is difficult to achieve remission. It is imperative that other methods to treat depression such as neuromodulation therapies, also known as brain stimulation therapies or techniques, should be used earlier than later in the disease to control effectively the depression and achieve a sense of well being in the elderly. Neuromodulation therapies available at this time are electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), magnetic seizure therapy (MST), and deep brain stimulation (DBS); these are invasive and are not office-based. Noninvasive therapies that are available are repetitive transcranial magnetic stimulation (rTMS) and direct transcranial direct current stimulation (tDCS). Other than ECT, limited data are available for other modes of therapy, but information available to date shows promise in treating this debilitating illness in the elderly.