全球60岁以上人群中老年抑郁症（late-life depression，LLD）的患病率高达28.4%，中国LLD的发病率为31.21%，其临床表现以躯体症状和认知损害为主，易被误诊为躯体疾病。神经影像学研究揭示LLD的病理机制与脑结构和功能异常密切相关，包括前额叶和海马等脑区灰质体积减少，默认网络过度激活与执行控制网络连接减弱等，这些发现为神经调控技术提供了治疗靶点。传统抗抑郁药物治疗的应答率仅为50%，部分存在心血管风险和认知功能影响，而无创神经调控技术展现出显著潜力。电休克疗法对重症患者的缓解率超过50%，但对认知功能不利的影响明显；磁抽搐疗法通过精准磁场刺激实现局灶性癫痫发作，疗效与电休克疗法相当，并且对认知功能影响更小；双侧重复经颅磁刺激及深部经颅磁刺激被推荐为LLD一线治疗方案；经颅直流电刺激则因安全性高而适用于轻至中度抑郁症患者。未来需结合多模态神经影像以评估和优化个体化参数，探索联合疗法及远程医疗的应用，以期提升LLD的诊疗效果。

The prevalence of late-life depression (LLD) among people over 60 years old worldwide is as high as 28.4%, and the incidence rate of LLD in China is 31.21%. Its clinical manifestations are mainly physical symptoms and cognitive impairment, which are easily misdiagnosed as physical diseases. Neuroimaging studies have revealed that the pathological mechanism of LLD is closely related to abnormal brain structure and function, including reduced gray matter volume in brain regions such as the prefrontal lobe and hippocampus, excessive activation of the default mode network (DMN), and weakened connections of the executive control network. These findings provide targets for neuroregulation therapy. The response rate of traditional antidepressant drugs is only 50%, and some have cardiovascular and cognitive risks. However, non-invasive neuroregulation techniques have shown significant potential. Electroconvulsive therapy (ECT) has a remission rate of over 50% for severe patients, but it has obvious cognitive side effects. Magnetic seizure therapy achieves focal epileptic seizures through precise magnetic field stimulation, with efficacy comparable to that of ECT and less cognitive impact. Bilateral repetitive transcranial magnetic stimulation (TMS) and deep TMS(dTMS) are recommended as first-line regimens. Transcranial direct current stimulation is suitable for patients with mild to moderate conditions due to its high safety. In the future, it is necessary to optimize individualized parameters by integrating multi-modal assessment, explore combined therapies and telemedicine applications, in order to improve the diagnosis and treatment effect of LLD.