Bilateral Repetitive Transcranial Magnetic Stimulation Decreases Suicidal Ideation in Depression

Weissman, Cory R.; Blumberger, Daniel M.; Brown, Patrick; Isserles, Moshe; Rajji, Tarek K.; Downar, Jonathan; Mulsant, Benoit H.; Fitzgerald, Paul B.; Daskalakis, Zafiris J.

doi:10.4088/jcp.17m11692

Cited by 52 publications

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“…Weissmann et al compared the effect of bilateral, left unilateral DLPFC, and sham rTMS on suicidal ideation in patients with TRD (who failed to respond to at least two antidepressant medications). They found a significant superiority of bilateral rTMS to sham rTMS in reducing suicidal ideation, with only a small portion of this reduction in suicidal ideation attributable to the improvement of overall depressive symptoms (59).…”

Section: Discussionmentioning

confidence: 99%

Anti-Suicidal Efficacy of Repetitive Transcranial Magnetic Stimulation in Depressive Patients: A Retrospective Analysis of a Large Sample

et al. 2020

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Background: Suicide is a major public health problem. About 90% of suicide victims have one or more major psychiatric disorder, with a reported 20-fold increased risk for suicide in patients with affective disorders in comparison with healthy subjects. Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or adjunctive treatment option for patients with depressive disorders, but little is known about its effects on suicide risk. Objective: For the assessment of the effectiveness of rTMS on suicidal ideation and behaviors, we performed a retrospective analysis of a large sample of patients with depressive disorders, who were treated with rTMS. Methods: We analyzed the records of 711 TMS in-and outpatients with depressive affective disorders in a tertiary referral hospital between 2002 and 2017. Out of these patients we were able to collect Hamilton depression rating scale (HAMD) data of 332 patients (180 females, 152 males; age range 20 to 79 years; mean age 47.3 ± 12.3) for which we analyzed the change of suicidal ideation by using item 3 (suicidality) of HAMD. Results: Out of all 711 patients treated with rTMS for their depression, one patient (0.1%) committed suicide during the TMS treatment. In the statistical analysis of the subsample with 332 patients there was an overall amelioration of depressive symptoms accompanied by a significant decrease in the suicidality item with a medium effect size. Decrease in suicidality was not inferior to changes in other items as indicated by effect sizes. Fortyseven percent of patients showed an amelioration in suicidality, 41.3% of patients did not show a change in their suicidality's scores, and 11.7% of patients showed an increase in suicidality's scores from baseline to final rating. Correlation of item 3 (suicidality) and item 7 (drive) demonstrated a significant positive association, revealing improved drive with a parallel decreased suicidality. Conclusion: Based on the proposed data, there is no evidence that rTMS increases the risk for suicide during the course of the treatment. Conversely, rTMS tends to reduce

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Section: Discussionmentioning

confidence: 99%

Anti-Suicidal Efficacy of Repetitive Transcranial Magnetic Stimulation in Depressive Patients: A Retrospective Analysis of a Large Sample

et al. 2020

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“…Although this theory may not have been based in sound empirical data and developments in neuroimaging and neurophysiology have enabled a better understanding of the pathophysiology of MDD, targeting both hemispheres may address a broader spectrum of pathology. Therefore, bilateral rTMS may address one of the factors that contribute to the variability in response rates in rTMS for MDD—not stimulating the involved cortical region …”

Section: Current Evidence On Optimization Of Hfl and Lfrmentioning

confidence: 99%

“…The authors underscored that bilateral rTMS is still potentially more effective than HFL due to a marginally nonsignificant relative OR, with sequential bilateral rTMS associated with the highest likelihood of response and remission. In addition, a recent report suggests that bilateral rTMS may have a more potent antisuicide effect than HFL alone . Randomized clinical trials on bilateral rTMS with low overall risk of bias are summarized in Table .…”

Section: Current Evidence On Optimization Of Hfl and Lfrmentioning

confidence: 99%

“…Therefore, bilateral rTMS may address one of the factors that contribute to the variability in response rates in rTMS for MDD-not stimulating the involved cortical region. 12,13 Although a recent network meta-analysis 4 demonstrated a robust superiority of bilateral rTMS over sham (OR, 3.39; 95% CI, 1.91-6.02), the authors reported a lack of superiority between bilateral rTMS and HFL for MDD. The authors underscored that bilateral rTMS is still potentially more effective than HFL due to a marginally nonsignificant relative OR, with sequential bilateral rTMS associated with the highest likelihood of response and remission.…”

Section: Bilateral Rtms With Hfl and Lfrmentioning

confidence: 99%

“…In addition, a recent report suggests that bilateral rTMS may have a more potent antisuicide effect than HFL alone. 12 Randomized clinical trials on bilateral rTMS with low overall risk of bias are summarized in Table 2.…”

Section: Bilateral Rtms With Hfl and Lfrmentioning

confidence: 99%

See 2 more Smart Citations

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder

Trevizol

Blumberger

2019

Clin Pharma and Therapeutics

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Repetitive transcranial magnetic stimulation (rTMS) has emerged as an evidenced‐based treatment for major depression that does not respond to standard first‐line therapies. The majority of data support the use of high‐frequency (10 Hz) treatment delivered to the left dorsolateral prefrontal cortex. Intermittent theta burst stimulation is a new emerging treatment that reduces the time required to deliver treatment and can increase capacity and access to this treatment. This review will comprehensively cover recent advancements in the field of rTMS for depression, including stimulation parameters and targets aimed at enhancing outcomes. In addition, efforts to use modern neuroscience tools to personalize this treatment and optimize outcomes will be reviewed.

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Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression

et al. 2020

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IMPORTANCE There is an unmet need for effective treatments for suicidality in mental disorders. Magnetic seizure therapy (MST) has been investigated as an alternative to electroconvulsive therapy, a known effective treatment for suicidality, in the management of treatment-resistant major depressive disorder, with promising findings. Yet, there are very limited data on the association of MST with suicidality directly. It is important to explore the potential of MST as a viable treatment alternative to electroconvulsive therapy for suicidality. OBJECTIVE To determine the association of MST with suicidality in patients with treatmentresistant major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial took place at a single tertiary care psychiatric facility in Canada. It followed an open-label study design with consecutive treatment cohorts. Consecutive groupings of 67 patients with treatment-resistant major depressive disorder and with baseline suicidality present were treated for up to 24 treatments. The study was run from February 2012 through June 2019. Patients were followed up for 6 months at the end of the treatment period. This post hoc secondary analysis of the trial was performed from January to November 2019. INTERVENTIONS MST was delivered at 100% stimulator output over the prefrontal cortex with low (25 Hz), moderate (50 or 60 Hz), or high (100 Hz) frequency, for a maximum of 24 sessions. MAIN OUTCOMES AND MEASURES Remission from suicidality was measured as an end point score of 0 on the Beck Scale for Suicidal Ideation. A linear mixed model was used to assess the trajectory of Beck Scale for Suicidal Ideation scores. RESULTS A total of 67 patients (mean [SD] age, 46.3 [13.6] years; 40 women [60.0%]) received a mean (SD) of 19.5 (5.1) MST treatments. The overall number of patients achieving remission was 32 (47.8%). Sixteen patients (55.2%) receiving low-frequency MST achieved remission, as well as 12 patients (54.5%) in the moderate-frequency group, and 4 patients (25.0%) in the high-frequency group. The linear mixed model revealed an association of time with Beck Scale for Suicidal Ideation scores (F 8,293.95 = 5.73; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that MST may be an effective treatment for suicidality, and sensitivity analysis shows this may be particularly so at low and moderate frequencies. Future studies should directly compare MST with electroconvulsive therapy for treating suicidality and should evaluate MST as a treatment for suicidality across mental disorders.

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Bilateral Repetitive Transcranial Magnetic Stimulation Decreases Suicidal Ideation in Depression

Abstract: ClinicalTrials.gov identifiers: NCT01515215 and NCT00305045.

Cited by 52 publications

References 0 publications

Anti-Suicidal Efficacy of Repetitive Transcranial Magnetic Stimulation in Depressive Patients: A Retrospective Analysis of a Large Sample

Anti-Suicidal Efficacy of Repetitive Transcranial Magnetic Stimulation in Depressive Patients: A Retrospective Analysis of a Large Sample

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder

Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression

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