Neuromodulation in Geriatric Psychiatry: an Update

Abstract Purpose of Review To evaluate existing literature looking at the indications, risks, and benefits of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and invasive vagus nerve stimulation (iVNS) in older adults, with a focus on papers published in the last 5 years. Provide an overview of recent developments in the field to better guide physicians in their management decisions. Recent Findings ECT and TMS have been more extensively studied in older adults. ECT is the most effective modality and takes the shortest amount of time to take effect. The vast majority of studies look at the use of these modalities in the treatment of depression. The three modalities have differing side effects and complications, notably general anesthetic (GA) risk in ECT and iVNS, cardiovascular complications and amnesia in ECT, and hoarseness in iVNS. Summary When thinking about which modality to recommend to an individual patient, it is important to consider diagnosis, disease severity, anaesthetic risk, and ability to attend in-person appointments. More prospective studies in the older adult population should be done, particularly in iVNS.