Repetitive TMS Boosts Quality of Life in Younger, Older Adults with Depression

A study showed that repetitive transcranial magnetic stimulation (TMS) provides acute and sustained clinically meaningful improvements in quality of life among younger and older adults with depression.1

“The magnitude of improvement was comparable to, or exceeded, that reported in antidepressant trials,” wrote study investigator Katharina Göke, PhD candidate, from the University of Toronto, and colleagues.

Repetitive TMS may be a well-established, FDA-approved intervention for treatment-resistant depression, but its impact on patient-reported outcomes, including quality of life, has not been fully explored.2 Investigators sought to compare the impact of repetitive TMS quality of life in younger and older adults with major depressive disorder (MDD).1

The sample included 531 participants aged 18 – 89 years from the randomized clinical trials THREE-D and FOUR-4. In those trials, participants received either unilateral or bilateral repetitive TMS or theta burst stimulation.

Investigators evaluated quality of life using the Quality-of-Life Enjoyment and Satisfaction Questionnaire – Short Form at baseline, end of treatment, and the 12-week follow-up. The team then compared quality of life between younger adults (< 60 years; n = 360) and older adults (age ≥ 60 years; n = 171).

The clinical significance of these quality-of-life changes was assessed using effect sizes, with a predefined threshold of 12 points set as the minimal clinically important difference. Investigators also assessed the significance of these changes by comparing results to community norms.

Following repetitive transcranial magnetic stimulation, both younger and adult adults displayed statistically significant improvements in quality of life, with medium to large effect sizes.

Participants had sustained improvements over the 12 weeks of follow-up. At baseline, only 0.3% of younger adults and 2.3% of older adults reported a normal quality of life, which significantly increased to 19.8% and 19.4%, respectively, at the end of treatment. At the 12-week follow-up, 23.7% and 26.8% of younger and older adults, respectively, reported a normal quality of life.1

Not only does this show repetitive TMS steadily improve quality of life in younger and older adults, but younger patients are more likely to have impaired quality of life than older adults.

“These findings suggest that younger adults are at greater risk of severe QoL impairment, possibly due to the more severe depressive symptoms observed in this age group,” investigators wrote.1

The differences observed in depressive symptom severity in this study may reflect the differing inclusion criteria of the THREE-D and FOUR-D trials. Specifically, THREE-D required a baseline HRSD-17 score of ≥18, whereas FOUR-D required a MADRS score of ≥18, which is equivalent to an HRSD-17 score of 14. This discrepancy likely explains why younger participants in our sample were more severely depressed than older participants.

Younger and older adults had slight differences in effect sizes when it came to improvement. Investigators found medium to large effect sizes in younger adults and medium effect sizes in older adults.

“This small difference may be explained by the higher baseline QoL in the older adult group, making improvements appear less pronounced relative to the younger adult group,” investigators wrote.1

Overall, younger and older adults demonstrated clinically meaningful improvement in quality of life, with 49.2% and 42.9% of the age groups, respectively, exceeding the threshold for an MCID of a 12-point change on the Q-LES-Q. This threshold equates to at least a “minimally improved” score on the Clinical Global Impression-Improvement Score.1

The study saw that the magnitude of change was larger for depression. Effect sizes were medium to large for quality of life (Cohen’s d = 0.70–0.81) and even larger for depression severity (d = 0.91–1.16), indicating that while both outcomes improved, depressive symptoms showed a stronger relative change. However, quality of life continued to improve over the 12-week follow-up, a pattern generally not seen with depressive symptoms.1

“This temporal pattern, together with the larger effect sizes observed for depressive symptoms relative to QoL and their strong correlation, supports the notion that QoL improvements are largely driven by preceding symptom reduction, although the relationship between QoL and depressive symptoms is likely bidirectional,” investigators wrote.1

References

1. Göke K, Downar J, Vila-Rodriguez F, et al. The effects of rTMS on self-reported quality of life in younger and older adults with major depressive disorder. Psychol Med. 2025;55:e303. Published 2025 Oct 8. doi:10.1017/S0033291725102079

2. Mayo Clinic. Transcranial Magnetic Stimulation. Mayoclinic.org. Published November 27, 2023. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625