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

2. Non-invasive neuromodulation The efficacy of ECT can be influenced by various
techniques parameters and treatment protocols. First, the placement
of electrodes significantly affects the effectiveness and
2.1. Electroconvulsive therapy (ECT) side effects of ECT. During ECT for depression, common
In clinical settings, ECT is frequently used to treat severe electrode placement strategies include bilateral (bilateral
depression, particularly among older patients. Several temporal and frontal lobes) and unilateral (right
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researchers contend that ECT is a safe and effective unilateral) placements. Among them, bilateral temporal
treatment modality for geriatric depression, characterized electrode placement is currently the most common
by a few absolute contraindications. 33,34 A meta-analysis method because it can quickly take effect in the early
reported symptom relief rates ranging from 50% to 90% in stages of treatment and relieve depressive symptoms.
older patients with depression treated with ECT, surpassing However, it is often reserved for urgent cases owing to
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those in younger patients, suggesting that age may be a its higher cognitive side effects. Conversely, unilateral
significant predictor of ECT efficacy. 33,35-39 In recent years, the ECT is linked to a reduced incidence of cognitive
emergence of modern modified ECT administered under side effects and may enhance cognitive function. 42,50
general anesthesia has significantly enhanced the safety and However, because of limited evidence, more studies
tolerability of ECT, making it the preferred treatment option are needed to determine the efficacy of unilateral ECT
in the clinical management of late-life depression. 40 versus a combination of bitemporal and unilateral ECT
in older patients with depression. In addition, the type
Studies have demonstrated that ECT can positively
affect the cognitive function of older patients with of ECT pulse also influences the alleviation of depressive
symptoms. A study reported that ultra-brief pulse
depression. Although ECT can have certain negative ECT demonstrates a superior capacity for minimizing
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effects on cognitive functions, particularly memory cognitive side effects relative to brief pulse ECT. However,
impairments, 42,43 these effects are generally transient it may exhibit reduced efficacy in alleviating depressive
and reversible. A comparative study did not reveal a symptoms. Furthermore, combining ultra-brief pulse
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significant decline in overall cognitive functions at 2 time ECT with venlafaxine was found to enhance efficacy,
points (1 week and 6 months) after ECT in older patients safety, and tolerability. Considering the aforementioned
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compared with baseline, including memory and executive evidence, adjusting ECT parameters and combining ECT
functions. Instead, cognitive indicators showed some with other treatment modalities can significantly affect
improvement. Another study reached a similar conclusion; the therapeutic outcomes and side effects in patients with
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although older patients might experience minor cognitive depression. Further studies are necessary to investigate
disturbances shortly after ECT, their cognitive functions
were significantly improved in the long term. 44 the synergistic application of various ECT protocols and
their integration with alternative therapeutic modalities
Studies have demonstrated the increased efficacy to develop more efficacious and lower-risk treatment
of ECT in alleviating depressive symptoms among strategies for geriatric patients suffering from depression.
older patients. 34,45 ECT not only serves as an effective In summary, ECT holds great promise in alleviating
maintenance therapy but also holds promise in preventing
relapse in depression, particularly among older people. In depressive symptoms in older patients. Nevertheless,
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considering the intricate comorbidities in this
addition, it exhibits positive therapeutic effects on patients demographic, customizing ECT parameters for each older
with comorbid dementia. 34,45 These findings suggest a patient will optimize treatment outcomes in the future. 52
potential beneficial effect of ECT on age-related cognitive
decline. A previous study revealed the long-term positive 2.2. Transcranial electrical stimulation
effects of ECT on cognition and mood. The cognitive and
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emotional benefits of ECT may be attributed to its ability to 2.2.1. Transcranial direct current stimulation (tDCS)
enhance monoaminergic neurotransmitter levels, increase tDCS is a non-invasive brain stimulation technique that
hippocampal volume, and promote neuroplasticity. has garnered widespread attention in recent years for its
Although the precise mechanisms remain to be elucidated, potential in treating geriatric depression. By applying
the positive effects of ECT on cognition and mood are likely low-intensity direct current (1 – 2 mA) through anode
mediated through improvements in neurotransmitter and cathode stimulations to specific scalp regions, tDCS
levels, brain structure, functional connectivity, and modulates cortical excitability levels. This modulation
ultimately, enhanced neuroplasticity. Further fundamental influences cerebral blood flow, metabolism, and brain-
and clinical studies are necessary to elucidate the precise derived neurotrophic factor levels, ultimately alleviating
mechanisms of action. depressive symptoms and enhancing cognitive function. 53-56

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