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Somatic Therapies: Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS)

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Geriatric Psychiatry

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Abstract

Somatic therapies are of particular importance in geriatric psychiatry, as older adults are often unable to tolerate adequate pharmacotherapy of depression. Among neurostimulation treatments, ECT remains the principal alternative to medications. However, newer treatments such as rTMS (repetitive transcranial magnetic stimulation) and DBS (deep brain stimulation) are emerging. rTMS involves stimulation of the brain using a magnetic coil applied to the scalp surface and is administered without anesthetic or loss of consciousness. It is very well tolerated by most patients and has a high degree of acceptability. Its efficacy for treating depression is more modest than that of ECT, and early evidence suggested that it was less effective in older patients. However, more recent rTMS treatment protocols involving longer treatment courses and higher intensity of treatment parameters are showing promise in treating depressive disorders in older adults, with response rates of 30–60% and remission rates of 10–30%. rTMS is a useful addition to the armamentarium of treatments in geriatric psychiatry; its place in treatment algorithms will evolve with emerging research and increased availability for routine clinical use. Its uses for other indications (e.g., for anxiety disorders), or to improve cognition in major neurocognitive disorder, are also being explored in current research. Direct bilateral stimulation of Brodmann area Cg 25 with implanted electrodes showed some promise in open trials, but subsequent randomized controlled trials failed to demonstrate its efficacy; it remains an investigational treatment.

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Authors and Affiliations

  1. Royal Ottawa Mental Health Centre, Ottawa, ON, Canada

    Lisa A. McMurray, Carole Lazaro & Timothy E. Lau MD, FRCPC

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  1. Lisa A. McMurray
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  2. Carole Lazaro
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  3. Timothy E. Lau MD, FRCPC
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Correspondence to Timothy E. Lau MD, FRCPC .

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Editors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

    Ana Hategan

  2. Baylor Scott and White Department of Psychiatry, Texas A&M University College of Medicine, Temple, Texas, USA

    James A. Bourgeois

  3. Division of General Medicine, University of California Davis Medical Center, Sacramento, California, USA

    Calvin H. Hirsch

  4. Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, California, USA

    Caroline Giroux

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McMurray, L.A., Lazaro, C., Lau, T.E. (2018). Somatic Therapies: Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS). In: Hategan, A., Bourgeois, J., Hirsch, C., Giroux, C. (eds) Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-67555-8_7

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