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Updated: Jul 14, 2025

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
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Treatment resistant depression in elderly.

Sheng-Chiang Wang1, Jennifer S Yokoyama2, Nian-Sheng Tzeng3

  • 1School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan; Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.

Progress in Brain Research
|October 8, 2023
PubMed
Summary
This summary is machine-generated.

Treatment refractory depression (TRD) in older adults is common and complex. A multimodal approach combining medication and non-pharmacological therapies is recommended for better outcomes in elderly patients with TRD.

Keywords:
Biophysical stimulationLate-life depressionNeurodegenerationNeuroinflammationPharmacological interventionPsychotherapyTreatment-resistant depressionWhite matter hyperintensities

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Area of Science:

  • Geriatric Psychiatry
  • Neuroscience
  • Pharmacology

Background:

  • Treatment refractory depression (TRD) significantly impacts the elderly, presenting with high comorbidity and mortality rates.
  • Older adults with TRD often experience complex comorbidities and risk factors, contributing to neuropsychiatric dysfunction and diminished treatment response.
  • Potential underlying mechanisms for TRD in the elderly include vascular, immunological, senescence-related, and abnormal protein deposition pathways.

Purpose of the Study:

  • To review and summarize current understanding of treatment refractory depression in the elderly.
  • To outline established and emerging treatment strategies for TRD in older adults.
  • To emphasize the need for a comprehensive approach to managing TRD in this demographic.

Main Methods:

  • Literature review of studies on treatment refractory depression in elderly populations.
  • Analysis of proposed pathophysiological mechanisms.
  • Synthesis of current pharmacological and non-pharmacological treatment modalities.

Main Results:

  • TRD in the elderly is characterized by complex clinical presentations and multifactorial etiology.
  • Treatment optimization, augmentation, switching, and combination strategies are key pharmacological interventions.
  • Non-pharmacological interventions like biophysical stimulation and psychotherapy play a crucial adjuvant role.

Conclusions:

  • A multimodal treatment strategy is essential for effectively managing TRD in the elderly.
  • Combining pharmacological and non-pharmacological interventions offers a more robust approach.
  • Further research into underlying mechanisms may yield more targeted therapies for geriatric TRD.