In older adults, TMS response ranged from 6.7% to 54.3% across trials, and the review calls efficacy still unclear
Seven randomised trials (260 people) and seven uncontrolled ones: response to TMS in geriatric depression ran from 6.7% to 54.3%, with "substantial variability" and "large heterogeneity" in dose and protocol.
Suggestive but preliminary. Not settled. how we score evidence
Caveat on this rating: Seven small RCTs with widely different doses cannot be added up, and the authors do not try. The absence of a pooled number is the finding.
Significant findings
Cappon and colleagues set out the problem plainly: treatment-resistant depression is common in older adults, who need treatments that spare cognition and coexist with other medicines, and "TMS is a proven intervention for treatment-resistant depression in younger adults but the efficacy of TMS to treat depressed older adults is still unclear". They searched PubMed, Embase and PsycINFO to March 2021 and found seven randomised controlled trials (260 people in total, 148 active, 112 control) and seven uncontrolled trials (160 people).
The result was a range, not a number. "Overall, we found substantial variability in the clinical response, ranging from 6.7% to 54.3%." The reviewed trials showed "large heterogeneity among studies both in terms of the employed TMS dosage and the observed clinical efficacy", which the authors read as a need to work out the right dose for the ageing brain rather than as a verdict either way.
Worth asking
A response rate somewhere between one in fifteen and one in two is not a rate a clinic can quote to an older patient as if it were one figure. Which trial, at what dose, is the offer based on, and how close is that to the protocol on the table?
Source
Transcranial magnetic stimulation (TMS) for geriatric depression — Cappon D, den Boer T, Jordan C, Yu W, Metzger E, Pascual-Leone A (2022)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1016/j.arr.2021.101531
DOI: 10.1016/j.arr.2021.101531
How this was scored
- Study design
- Systematic review of observational studies
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- 260
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 15, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "early signal". Suggestive but preliminary. Not settled. It scores 53 out of 100 on our published rubric. One caveat travels with that badge: Seven small RCTs with widely different doses cannot be added up, and the authors do not try. The absence of a pooled number is the finding. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Transcranial magnetic stimulation (TMS) for geriatric depression — Cappon D, den Boer T, Jordan C, Yu W, Metzger E, Pascual-Leone A (2022). Published in: Reputable peer-reviewed journal. DOI: 10.1016/j.arr.2021.101531. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of observational studies. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.