Neurostimulation may reduce suicidal ideation for some with depression

Repetitive transcranial magnetic stimulation can be an effective treatment for suicidal ideation in patients with treatment-resistant depression, according to a meta-analysis published in the Journal of Clinical Psychiatry.

“A sizeable proportion of patients with major depressive disorder who do not respond to first-line treatment can go on to develop treatment-resistant depression. This prolonged illness leads to decreases in productivity, diminished quality of life, more hospitalizations, increased health care costs and a higher risk of suicidal ideation,” Shobha Mehta, BSc, of the Temerty Centre for Therapeutic Brain Intervention and the Centre for Addiction and Mental Health in Toronto, and colleagues wrote.

Mehta and colleagues sought to scan existing literature on the influence of repetitive transcranial magnetic stimulation (rTMS) against suicidal ideation (SI) in patients diagnosed with treatment-resistant depression (TRD). They searched for studies using PubMed, SCOPUS, Ovid, MEDLINE, Embase and Web of Science from each database’s inception until Jan. 11, 2021. Analysis was undertaken by using keywords related to depression, suicide and the treatment itself.

The final analysis included 16 publications, all of which featured works regarding the effects of rTMS in 833 patients aged 16 years or older who had been diagnosed with unipolar or bipolar depression, which included suicidal ideation data prior to and following treatment with rTMS. Six publications featured randomized controlled trials, four were open-label trials, three were retrospective analyses of primary studies, two were case series and the last was a single-blind trail.

Data was then extracted through Covidence to include authors, publication year, country of origin, study design, patient demographics, primary diagnosis, comorbidities, mean age, outcome assessment instruments, detailed stimulation parameters and sham control procedures, along with any significant adverse events related to SI. Primary outcome for the purposes of the analysis was to track any changes in SI score from the initiation of treatment with rTMS until its end.

Results showed a nonsignificant decrease in SI scores for all randomized controlled trials included in the analysis, whereas as a significant decrease in SI scores was found in all uncontrolled trials.

The findings suggest that rTMS can be an effective treatment.

“The discrete effects on SI warrant further investigation,” Mehta and colleagues wrote.

“The added benefits of requiring no anesthesia, being available on an outpatient basis and having minimal side effects make rTMS an increasingly attractive option to patients with TRD.”