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Journal of Clinical and
Basic Psychosomatics Non-invasive neuromodulation for geriatric depression

1. Introduction often leads to drug interactions, thereby increasing the
risk of adverse reactions. Furthermore, low drug tolerance
Geriatric depression, a psychological disorder, first and high incidence of side effects such as gastrointestinal
emerges or recurs during old age. As depression can affect discomfort, sleep disturbances, and dizziness further limit
1
individuals at any point in the life span, the age criteria the effectiveness of pharmacological treatments in older
for late-life depression in most studies align with the people. Consequently, 20 – 40% of older patients with
19
current definition of “elderly” individuals, typically those depression exhibit a suboptimal response to standard
aged ≥60 years. Although the American Psychiatric pharmacological treatments. 20-22 Approximately 45% of
1-3
Association does not specify an age threshold for late- older patients with depression may experience irreversible
life depression in the Diagnostic and Statistical Manual cognitive damage during the course. Poor treatment
23
of Mental Disorders, in clinical practice, patients aged 60 outcomes or adverse reactions may result in non-adherence
or ≥65 years with depression are often considered to have to medications, increasing the relapse risk. Although
24
late-life depression. However, the age criteria for late-life psychotherapies, particularly cognitive behavioral therapy
4-6
depression can vary across studies, with some setting the and interpersonal therapy, are known for recognized for
age threshold at ≥55 or even ≥75 years, depending on the their positive therapeutic effects on geriatric depression,
research objectives and the characteristics of the population the high cost, prolonged treatment, and slow onset of action
under investigation. Treatment-resistant depression associated with psychotherapy pose significant limitations
7,8
refers to individuals with depression who have shown an when applied to late-life depression. Cognitive decline and
25
inadequate response to treatment with at least two different reduced plasticity in older people may also diminish the
9
classes of conventional antidepressant medications. A response to psychotherapy. Moreover, older patients with
23
study indicated that the prevalence of treatment-resistant depression often suffer from severe sleep problems, such
depression is higher among older adults, who often present as insomnia and early morning awakening, which may be
with more severe depressive symptoms and are frequently related to abnormalities in their rapid eye movement sleep,
associated with higher comorbidity rates. This poses potentially reduced to 20 – 60 min, compared with the
10
additional difficulties and challenges for older patients normal range of 90 – 100 min. 26,27 Given these physiological
during the treatment process, particularly in drug therapy. factors, psychotherapy alone is often less effective. 28,29
With the rapid aging of the global population, the Finally, older patients with depression often have executive
prevalence of older patients continues to increase, dysfunction, which significantly affects their basic daily
imposing a significant burden on both individuals and living and household abilities, and both pharmacological
society. Globally, the incidence of late-life depression and psychotherapeutic treatments have limited efficacy
11
ranges from 10% to 20%, depending on culture and in improving this functional impairment. Therefore, a
30
region. Emotional disturbances (such as apathy), loss treatment strategy for older patients with depression that
12
of interest, sleep disorders, cognitive impairments, and prioritizes safety and rapid therapeutic effects is an urgent
executive dysfunction are typical symptoms of late-life need.
depression. 13-15 These symptoms are closely associated Compared with traditional medication and
with a higher number of physical comorbidities, such as psychotherapy, new non-invasive neurostimulation
arthritis, angina, cardiovascular diseases, diabetes, and techniques such as repetitive transcranial magnetic
mortality rates. Moreover, a meta-analysis study revealed stimulation (rTMS), transcranial electrical stimulation,
1
that compared with younger patients, older individuals are and bright light therapy (BLT) have gained attention
more likely to exhibit agitation, hypochondriasis, somatic owing to their high safety profile, high compliance rates,
pre-occupation (including gastrointestinal issues), and rapid onset of action, affordability, and minimal side
loss of interest. Late-life depression is characterized by effects. 31-33 These characteristics indicate the potential of
16
poor prognosis, slow progression, and high recurrence these techniques for treating geriatric depression. Building
rates, severely affecting patients’ quality of life and social upon a comprehensive review of current literature on
17
functioning. This has led to augmented research attention non-invasive neurostimulation techniques for treating
on the treatment of late-life depression. 13,14 geriatric depression, this review aimed to summarize the

At present, pharmacotherapy and psychotherapy effectiveness and safety of various non-invasive brain
are the primary treatment modalities for geriatric technologies in treating depression in the elderly. It aimed
depression. The first-line treatment of geriatric depression to provide initial insights into the mechanisms, protocols,
is selective serotonin reuptake inhibitors and serotonin– and parameter selection of different technological
norepinephrine reuptake inhibitors. Nevertheless, the high approaches for treating geriatric depression and offer a
18
prevalence of comorbidities among the older population perspective on future development in this field.

Volume 3 Issue 3 (2025) 2 doi: 10.36922/jcbp.5019