Several controlled studies suggest that high-frequency repetitive transcranial
magnetic stimulation is associated with antidepressant effects.1- 5
Interestingly enough, the 2 studies investigating relatively older depressed
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
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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