Transcranial magnetic stimulation and the treatment of suicidality

Sher, Leo; Mindes, Janet; Novakovic, Vladan

doi:10.1586/ern.10.166

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…Therefore there is a great need to firstly develop new treatment modalities with a rapid effect on suicide risk in order to prevent suicide (18,47) and to secondly assess the effects of established antidepressant treatments on suicidal ideation.…”

Section: Discussionmentioning

confidence: 99%

“…First, neither antidepressants nor psychotherapy work fast enough for reduction of suicidal ideation. Second, even for medications with well-established reduction in suicidal behavior such as lithium, effectiveness is limited (18). Third, the prescription of antidepressants may offer the depressed patient a potential suicide method, e.g., by intoxication with tricyclic antidepressants, which are known for their cardiotoxicity (19).…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…Worldwide, over 800,000 people die of suicide every year and the number of non-fatal suicide attempts is estimated to be more than twenty times higher (WHO, 2014 report). Except for electroconvulsive therapy (ECT), few treatments for suicidal ideation and behavior (e.g., lithium, ketamine and clozapine) are available and these are only partially effective (Sher et al, 2010 ). Furthermore, the utility of ECT is limited due to safety concerns and adverse events.…”

Section: Introductionmentioning

confidence: 99%

“…Repetitive Transcranial Magnetic Stimulation (rTMS) has well-documented positive effects on depression without major side effects (Schutter, 2009 ). A review of the literature indicates that rTMS improves several preconditions for suicide, including mood, memory, attention, executive functioning and other neuropsychological dysfunctions, such as choosing immediate reward over larger, delayed rewards (Figner et al, 2010 ; Sher et al, 2010 ). Moreover, rTMS is thought to have molecular effects similar to those seen with ECT, which is also applied in suicidal patients, such as increased BDNF, increased monoamine turnover and normalization of the hypothalamic-pituitary-adrenal axis (George, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

Accelerated Intermittent Theta Burst Stimulation for Suicide Risk in Therapy-Resistant Depressed Patients: A Randomized, Sham-Controlled Trial

Desmyter

Duprat

Baeken

et al. 2016

Front. Hum. Neurosci.

101

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Objectives: We aimed to examine the effects and safety of accelerated intermittent Theta Burst Stimulation (iTBS) on suicide risk in a group of treatment-resistant unipolar depressed patients, using an extensive suicide assessment scale.Methods: In 50 therapy-resistant, antidepressant-free depressed patients, an intensive protocol of accelerated iTBS was applied over the left dorsolateral prefrontal cortex (DLPFC) in a randomized, sham-controlled crossover design. Patients received 20 iTBS sessions over 4 days. Suicide risk was assessed using the Beck Scale of Suicide ideation (BSI).Results: The iTBS protocol was safe and well tolerated. We observed a significant decrease of the BSI score over time, unrelated to active or sham stimulation and unrelated to depression-response. No worsening of suicidal ideation was observed. The effects of accelerated iTBS on mood and depression severity are reported in Duprat et al. (2016). The decrease in suicide risk lasted up to 1 month after baseline, even in depression non-responders.Conclusions: This accelerated iTBS protocol was safe. The observed significant decrease in suicide risk was unrelated to active or sham stimulation and unrelated to depression response. Further sham-controlled research in suicidal depressed patients is necessary. (Clinicaltrials.gov identifier: NCT01832805).

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“…Other studies have discussed that rTMS can affect the emotional and cognitive state of patients ( 19 ), and that patients with suicidal ideation and behavior often have damage to areas of the brain that are involved in cognitive and emotional control functions ( 20 , 21 ), and that the targets of TMS happen to be implicated in these brain areas ( 22 ), which lends support to the idea that TMS would be expected to be an effective treatment for suicide and its potential use as a treatment for suicidal ideation.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Transcranial Magnetic Stimulation for Reducing Suicidal Ideation in Depression: A Meta-Analysis

et al. 2022

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ObjectivesThis study aimed to systematically review the efficacy of transcranial magnetic stimulation treatment in reducing suicidal ideation in depression.MethodsPubMed, Web of Science, CBMdisc, WanFang, Chongqing VIP, and CNKI databases were electronically searched for randomized controlled trials of transcranial magnetic stimulation (TMS) intervention in the management of suicidal ideation from inception to February 24, 2021. Two reviewers independently screened studies, extracted data, and assessed the quality of included studies. Meta-analysis was then performed using STATA 15.1 software.ResultsA total of eight articles involving 566 patients were included. The meta-analysis results showed that the suicidal ideation scores of the group who received TMS treatment were significantly lower [standardized mean difference (SMD) = −0.415, 95% confidence interval (CI): −0.741 to −0.090, P = 0.012] than those of the control group. Subgroup analysis showed that age, TMS pattern, frequency of intervention, and stimulation threshold altered the TMS efficacy.ConclusionsEvidence showed that TMS achieved superior results in reducing suicidal ideation. Because of the limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.Systematic Review Registrationhttps://inplasy.com/, identifier: INPLASY202180065.

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Transcranial magnetic stimulation and the treatment of suicidality

Cited by 9 publications

References 32 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

Accelerated Intermittent Theta Burst Stimulation for Suicide Risk in Therapy-Resistant Depressed Patients: A Randomized, Sham-Controlled Trial

Efficacy of Transcranial Magnetic Stimulation for Reducing Suicidal Ideation in Depression: A Meta-Analysis

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