Transcranial magnetic stimulation for the management of late life depression: a critical appraisal of available evidence.

Late-life depression (LLD) is a prevalent and often underdiagnosed condition in older adults, associated with significant cognitive, functional, and medical burdens. Conventional treatments frequently present limitations in this population, underscoring the need for safer, more effective alternatives. This review evaluates the growing body of evidence supporting transcranial magnetic stimulation (TMS) as a promising nonpharmacological treatment for LLD. Recent meta-analyses and randomized controlled trials suggest that TMS is effective and well tolerated in older adults, even in cases of treatment resistance. Protocol adaptations, such as increased stimulation intensity and the use of theta burst or deep TMS, have demonstrated improved outcomes in this population. TMS also shows potential cognitive benefits and fewer systemic side effects compared to pharmacotherapy. However, barriers such as limited accessibility, insurance restrictions, and logistical challenges persist. TMS represents a valuable therapeutic option for managing LLD, particularly in patients who are medication-intolerant or at high risk for adverse effects. While evidence supports its efficacy and safety, further research is needed to optimize protocols, identify predictors of response, and assess long-term outcomes. Addressing implementation challenges will be essential for translating these advances into routine clinical practice.