The effects of rTMS on self-reported quality of life in younger and older adults with major depressive disorder

Background Repetitive transcranial magnetic stimulation (rTMS) is a well-established intervention for treatment-resistant depression. However, its effects on patient-reported outcomes, such as quality of life (QoL), have not been fully characterized, especially among older adults. This study compares the impact of rTMS on QoL in younger (<60 years) versus older (≥60 years) adults with major depressive disorder. Methods We analyzed data from 531 participants with depression (ages 18–89 years) from two randomized clinical trials (THREE-D and FOUR-D). All participants received either unilateral or bilateral rTMS or theta burst stimulation. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form at baseline, end of treatment, and 12-week follow-up, and compared between younger adults (age < 60 years; n = 360) and older adults (age ≥ 60 years, n = 171). The clinical relevance of the changes was evaluated through effect sizes, using a predefined threshold of 12 points as the minimal clinically important difference, and comparisons with community norms. Results After rTMS treatment, both younger and older adults experienced statistically significant improvements in QoL, with medium to large effect sizes. The effect was sustained over 12 weeks of follow-up. At baseline, only 0.3% of younger adults and 2.3% of older adults reported normal QoL, which significantly increased to, respectively, 19.8 and 19.4% by the end of treatment, and 23.7 and 26.8% at the 12-week follow-up. Conclusions rTMS yielded acute and sustained clinically meaningful improvements in QoL, with similar effects among younger and older adults with depression. The magnitude of improvement was comparable to, or exceeded, that reported in antidepressant trials.