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Letters to the Editor |

Antidepressant Effects of Repetitive Transcranial Magnetic Stimulation in the Elderly: Correlation Between Effect Size and Coil-Cortex Distance

Urs P. Mosimann, MD; Susanne C. Marré, MD; Stefan Werlen, MD; Wolfgang Schmitt, MD; Christian W. Hess, MD; Hans U. Fisch; Thomas E. Schlaepfer, MD
Arch Gen Psychiatry. 2002;59(6):560-561. doi:.
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Several controlled studies suggest that high-frequency repetitive transcranial magnetic stimulation is associated with antidepressant effects.15 Interestingly enough, the 2 studies investigating relatively older depressed patients2,5 demonstrated a lesser effect than did the studies performed in a younger population. This is in stark contrast to the finding that another method of brain stimulation, electroconvulsive therapy, is somewhat more effective in older patients.6 Figiel et al2 assumed that this finding could be associated with the structural brain changes that are often found in older depressed patients.7 Lai and colleagues8 were recently able to demonstrate an orbitofrontal cortex volume reduction in geriatric depressed patients. Kozel et al9 investigated the relationship of the distance between the stimulating coil and the cortex to age and antidepressant response and were not able to find a significant correlation in 12 patients with a mean age of 42 years; however, they demonstrated that treatment responders were younger and had a shorter prefrontal coil-cortex distance.

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A, A ratio of the distance from the stimulating coil (marked with a lead ball to the surface of the cortex [distance 1] and another from the coil to the contralateral side ventricle [distance 2], used as a proxy for total brain volume) was obtained at the motor cortex and at the dorsolateral prefrontal cortex (DLPFC). The coil-cortex distance index is the difference between the ratio at the prefrontal cortex and the one at the DLPFC, thus taking into account a putative disproportionate atrophy of the cortices. B, Graphic illustration of a significant correlation of this index with the decrease in depression rating as assessed with the Hamilton Depression Scale (HAMD).

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