Brain Stimulation and Treatment of Depression in Older Adults: Recent Advances and Perspectives

Sébastien GENTY
May 21
2 min read

Depression in older adults: A major public health challenge with promising new treatments from brain stimulation

Depression among older adults remains a major public health challenge, often underdiagnosed and inadequately treated. Recent advancements in brain stimulation technology offer promising new perspectives for treating resistant depression in this vulnerable population.

State of Brain Stimulation Techniques

Several non-invasive brain stimulation techniques have shown encouraging results:

Repetitive Transcranial Magnetic Stimulation (rTMS):

Response rates between 50 and 55%, remission rates between 30 and 35% in patients with major depression.
Primarily targets the dorsolateral prefrontal cortex (DLPFC), which is dysregulated in depressive patients.

Transcranial Direct Current Stimulation (tDCS):

Uses a low current (1 to 2 mA) applied via electrodes.
A recent study demonstrated a slowdown in cognitive decline in elderly individuals with remittent major depressive disorder or mild cognitive impairment.

Vagus Nerve Stimulation (VNS):

FDA approved since 2005 for chronic or recurrent resistant depression.
A recent study showed significant antidepressant benefits, although the primary evaluation criterion was not met.

Innovations and Outlook

Home Stimulation Devices:

Researchers have developed a tDCS device that can be used at home, showing a remission rate of 44.9% versus 21.8% for the placebo group.
This approach could improve treatment accessibility and compliance.

Intensive Protocols:

The ONE-D protocol, based on the SNT/SAINT approach, aims to concentrate treatment into a single day, with promising results.

Personalized Treatment:

The use of neuronavigation based on functional MRI allows for optimized targeting of stimulation.

Specific Benefits for Older Adults

Safety:

Brain stimulation techniques avoid some side effects associated with antidepressants, particularly problematic in the elderly due to polypharmacy.

Cognitive Efficacy:

tDCS has shown beneficial effects on cognitive decline, a crucial aspect for the elderly population.

Complementary Treatment:

Brain stimulation can be used in addition to existing treatments, increasing the chances of success in resistant cases.

Challenges and Future Considerations

Accessibility and Cost:

Deep brain stimulation remains an expensive technique (about 50,000 euros per patient).
Efforts are needed to make these treatments more accessible and affordable.

Standardization of Protocols:

Recent guidelines and expert consensus on rTMS (2025) highlight the importance of standardizing approaches.

Ongoing Research:

Additional studies are needed to determine the patient profiles that would benefit most from these treatments.
The assessment of long-term effects, especially in older individuals, remains crucial.

Conclusion

Brain stimulation represents a significant advancement in the treatment of resistant depression in older adults. Recent innovations, such as home devices and intensive protocols, pave the way for more accessible and personalized treatments. However, challenges remain in terms of cost, accessibility, and standardization of protocols.

Ongoing research in this field, as evidenced by events during Brain Week 2025, continues to refine our understanding and optimize these therapeutic approaches. Integrating these techniques into standard treatment protocols for elderly patients with resistant depression could significantly transform the care of this vulnerable population, offering new hope where traditional treatments have failed.

Written by: Sébastien GENTY