- Neurostimulation treatments use electricity or magnetic fields on the brain. Stimulating the brain in these ways can produce durable increases or decreases in the activity of target brain regions, lasting weeks to months can thus normalize the activity of regions that are hyperactive or hypoactive in major depressive disorder. It can also increase chemical messengers (neurotransmitters) needed to relieve symptoms of depression.
- More work needs to be done to know how well Neurostimulation treatments work, especially in older adults.
- Neurostimulation treatments are usually only used after a lot of time has gone by and your depressive symptoms have not changed from other treatments you have tried, such as psychological treatment, medication, and self-help or alternative treatments. Talk with your family doctor or mental health professional to see if Neurostimulation treatments are a good option for you.
Electroconvulsive Therapy (ECT)
What is ECT?
- Electroconvulsive Therapy (ECT) is a treatment for depression where electrical currents give the brain a seizure on purpose. This is done safely, under complete anaesthesia and won’t damage the brain.
- The electrical currents cause chemical changes in the brain that help relieve symptoms of depression.
- ECT has been used to treat depression for more than 70 years. Even so, the exact reason why ECT works to relieve depressive symptoms is not completely known.
- ECT is usually presented as an option when depressive symptoms are either very severe or not getting better after other types of treatment have been tried.
Does ECT work?
- ECT works for older adults with severe depression or depression that has been resistant to other types of treatment.
- Like other treatments for depression, each person may respond differently to ECT.
- ECT and antidepressants are used for different types of depression.
- The safety of ECT for older adults with depression who also have other health problems, such as cerebrovascular disorders, Alzheimer’s disease, or vascular dementia is generally assessed by a team of physicians (including psychiatrists and anaesthesiologists) prior to ECT.
What are the risks and side effects of ECT?
- ECT is generally considered a safe and well-tolerated treatment for older adults.
- Some side effects may occur during and after treatment but are usually mild and temporary, for example:
- memory problems
- slower thinking speed
- cardiovascular problems
- increased risk of falls
- Some people worry about how ECT might impact brain health. Apart from temporary confusion or memory problems and slower thinking speed, there is no evidence that ECT causes continued cognitive side effects or cognitive decline.
- More research is needed to understand the long-term effects of ECT on memory.
- It is important for you and your doctor or treatment provider to monitor your thinking and memory skills before, during, and after ECT.
What happens when I get ECT and how long does it take?
- When getting ECT, you will first be given medication with anesthesia to sedate you. Electrodes are placed in one or two different locations on the surface of your head and electrical currents delivered.
- You initially need between 6-12 ECT treatments (delivered twice weekly) for complete improvement of your depression.
- You may benefit from further ECT sessions in the months following your first treatment (called maintenance electroconvulsive therapy) to prevent relapse or the return of depressive episodes.
- ECT may produce faster responses in reducing depressive symptoms as compared to antidepressants.
Repetitive Transcranial Magnetic Stimulation (rTMS)
What is rTMS?
- rTMS is a newer treatment for depression that uses magnetic fields.
- rTMS uses powerful, focused magnetic field pulses to induce electrical currents in target brain regions.
- The pulses are delivered through a coil placed against the scalp over the target area
- rTMS can produce increases or decreases in the activity of target brain regions, lasting weeks to months and can thus normalize the activity of regions that are hyperactive or hypoactive in depression.
- rTMS can sometimes be given as an alternative to ECT if your depressive symptoms are not very severe. Compared to ECT, rTMS is not as invasive, does not induce seizure, has fewer side effects, does not cause thinking or cognitive problems, and does not require sedation with anesthesia.
Does rTMS work?
- Like ECT, rTMS is generally considered for older adults with depression that has been resistant to other types of treatment. However, it is not the best treatment for severe depression.
- Like other treatments for depression, each person may respond differently to rTMS.
- Continued research is needed to know more fully the effects of rTMS on older adults and how it compares to other types of treatment.
- Although there is not a lot known about rTMS for the older adults, some experts suggest rTMS may be especially beneficial for older adults. One benefit is that it can be used for treatment-resistant depression (when symptoms have not reduced with other treatment).
- There is not enough research to recommend this as a regular treatment of depression among older adults. Talk to your doctor if you are considering trying rTMS.
What are the risks and side effects of rTMS?
- rTMS is generally considered a safe and well-tolerated treatment for older adults.
- Some common side effects include:
- discomfort of the scalp
- transient headaches
What happens when I get rTMS and how long does it take?
- When getting rTMS, you will first get several measurements to make sure coils are properly positioned around your head. A series of magnetic pulses are then given for about 30 minutes. Newer form of rTMS, called theta burst stimulation takes just over three minutes per treatment.
- rTMS is usually given 5 days a week for about 4 to 6 weeks. It is delivered in an out-patient setting and does not require staying in a hospital overnight.
Disclaimer: Information in this pamphlet is offered ‘as is’ and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
For More Information See:
- Counselling or Therapy to Treat Depression in Older Adults
- Pharmacotherapy (Medication Treatment) for Depression in Older Adults
- Exercise for Depression in Older Adults
- Alternative Treatments for Depression in Older Adults
- Blumberger, D. M., Hsu, J. H., & Daskalakis, Z. J. (2015). A Review of Brain Stimulation Treatments for Late-Life Depression. Current Treatment Options in Psychiatry, 2(4), 413–421.
- Gardner, B. K., & O’Connor, D. W. (2008). A Review of the Cognitive Effects of Electroconvulsive Therapy in Older Adults. The Journal of electroconvulsive therapy, 24(1), 68–80.
- Kumar, S., Mulsant, B. H., Liu, A. Y., Blumberger, D. M., Daskalakis, Z. J., & Rajji, T. K. (2016). Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression. American Journal of Geriatric Psychiatry, 24(7), 547–565.
- Sabesan, P., Lankappa, S., Khalifa, N., Krishnan, V., Gandhi, R., & Palaniyappan, L. (2015). Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls. World J Psychiatr, 5(2), 170–181.
- Stek, M. L., Wurff van der, F., Hoogendijk, W. L., & Beekman, A. T. F. (2010). Electroconvulsive therapy for the depressed elderly. Cochrane Database of Systematic Reviews (Online), (2).
- van Schaik, A. M., Comijs, H. C., Sonnenberg, C. M., Beekman, A. T., Sienaert, P., & Stek, M. L. (2012). Efficacy and Safety of Continuation and Maintenance Electroconvulsive Therapy in Depressed Elderly Patients: A Systematic Review. The American Journal of Geriatric Psychiatry, 20(1), 5–17.
Download: Fact Sheet: Neurostimulation Treatments for Depression in Older Adults
Last Updated: May 2020