What question did this study set out to answer?

This study aims to compare the effectiveness of rTMS and tDCS in reducing depressive symptoms and improving functional recovery in older inpatients.

March 15, 2026Open Access

Non-Invasive Brain Stimulation in Older Inpatients with Depression: A Real-World Comparison of Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcranial Direct Current Stimulation (tDCS) on Depressive Symptoms and Functional Recovery

Key Points

This study aims to compare the effectiveness of rTMS and tDCS in reducing depressive symptoms and improving functional recovery in older inpatients.
Conducted a retrospective, naturalistic comparative study
Included 104 inpatients aged ≥60 with depression
Assessed depression severity using HDRS21 at baseline, 2 weeks, and 1 month
Used covariate-adjusted mixed-effects models and χ2 tests for analysis
Applied propensity score matching to minimize confounding effects.
rTMS group had significantly higher response rates (87.5% vs. 55.4%) compared to tDCS (p < 0.001)
Remission rates were higher in the rTMS group (62.5% vs. 41.1%, p = 0.047)
HDRS21 score reductions were greater in the rTMS group at both 2 weeks and 1 month (p < 0.001)
Global Assessment of Functioning scores improved in both groups without significant differences (p = 0.56).

Abstract

Background: Non-invasive brain stimulation (NIBS) is increasingly used as an adjunctive option in late-life depression (≥60 years), a condition frequently complicated by multimorbidity and incomplete response to standard treatments. Comparative real-world evidence between repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), particularly including functional outcomes, remains limited. Methods: We conducted a retrospective, naturalistic comparative study of 104 depressed inpatients (≥60 years), either unipolar or bipolar, treated with rTMS (n = 48) or tDCS (n = 56) as part of routine care. Depression severity was assessed with the 21-item Hamilton Depression Rating Scale (HDRS21) at baseline, 2 weeks, and 1 month; response was defined as ≥50% HDRS21 score reduction and remission as HDRS21 < 7 at 1 month. Global Assessment of Functioning (GAF) was assessed at admission and discharge (baseline and 1 month). Longitudinal changes were examined using covariate-adjusted mixed-effects models; categorical outcomes were compared using χ2 tests. Propensity score matching was applied as an additional approach to reduce confounding due to the observational design. Results: At 1 month, response and remission rates were significantly higher in the rTMS group than in the tDCS group (87.5% vs. 55.4%, p < 0.001; 62.5% vs. 41.1%, p = 0.047, respectively). rTMS showed greater HDRS21 score reductions at 2 weeks and 1 month (Time × Treatment, p < 0.001). GAF scores significantly improved over time in both groups (Time effect, p < 0.001) without between-technique differences (Time × Treatment, p = 0.56), and GAF scores did not differ by response/remission status. Conclusions: In this cohort of inpatients aged ≥ 60 years with depressive episodes, rTMS was associated with greater short-term reductions in HDRS21 scores compared with tDCS, whereas both modalities showed comparable improvements in GAF from admission to discharge.

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