Top cited papers in international psychogeriatrics: 5. A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly.

We were delighted, but surprised, by the publication success of our first pilot trial on the efficacy of repetitive transcranial magnetic stimulation (rTMS) to treat late life depression (LLD) (Manes et al., 2001). This preliminary study had major limitations – for example, the small sample size and the use of both a non-therapeutic dose of rTMS and a defective method of sham stimulation. However, it addressed an important clinical problem for which we still do not have a satisfactory solution: how do we treat LLD that has been resistant to the usual therapeutic approaches in a safe and efficient way? In order to give a tentative response to this question we need to describe briefly the characteristics of LLD, the available evidence regarding the efficacy of common antidepressants in this condition, and the role that coexisting cerebrovascular disease plays in treatment response.