Effects of repetitive transcranial magnetic stimulation on suicidal behavior: A systematic review

Serafini, Gianluca; Canepa, Giovanna; Aguglia, Andrea; Amerio, Andrea; Bianchi, Davide Gianluca; Magnani, Luca; Dell’Osso, Bernardo; Pompili, Maurizio; Fitzgerald, Paul B.; Amore, Mario

doi:10.1016/j.pnpbp.2020.109981

Cited by 18 publications

(12 citation statements)

References 49 publications

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“…This suggests an anti-suicidal effect of rTMS that may be partially independent of mood improvement in of itself, akin to what has been reported elsewhere. [27][28][29][30][31][32] Rapid anti-suicidal effects of rTMS could prove an important area of study, especially in emergency care and inpatient settings where quick relief is needed.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Miron

Hyde

Fox

et al. 2020

Preprint

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BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an effective intervention in major depressive disorder (MDD) but requires daily travel to a treatment clinic over several weeks. Shorter rTMS courses retaining similar effectiveness would thus increase the practicality and scalability of the technique, and therefore its accessibility. OBJECTIVE We assessed the feasibility of a novel 5 day accelerated 1 Hz rTMS protocol. We hypothesized that this novel rTMS protocol would be safe and well-tolerated while shortening the overall treatment course. METHODS We conducted a prospective, single-arm, open-label feasibility study. Thirty (30) participants received a one-week (5 days) accelerated (8 sessions per day, 40 sessions total) course of 1 Hz rTMS (600 pulses per session, 50-minute intersession interval) over the right dorsolateral prefrontal cortex (R-DLPFC) using a figure-of-eight coil at 120% of the resting motor threshold (rMT). Depression severity was assessed on the Beck Depression Inventory-II (BDI-II) and 17-item Hamilton Rating Scale for Depression (HRSD-17). RESULTS Response and remission rates 1 week after treatment were 33.3% and 13.3% respectively and increased to 43.3% and 30.0% at 4 weeks after treatment. No serious adverse events occurred. All participants reported manageable pain levels. CONCLUSION 1 Hz rTMS administered 8 times daily for 5 days is safe and well-tolerated. Efficacy at the end of the course was similar to a standard daily course of 1 Hz rTMS, and there appears to be an additional delayed effect. Further validation in a randomized trial is required.

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Section: Resultsmentioning

confidence: 99%

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Miron

Hyde

Fox

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Transcranial magnetic stimulation (TMS) is a non-invasive and painless neuromodulation tool acting on the underlying neuronal excitability. This modulation is achieved by inducing an electrical current discharge in a coil generating a magnetic field, which then induces depolarization of membrane potentials in the cortical tissue beneath the coil, and affects the activity of the associated nerve loop ( 284 ). According to Chen et al ( 285 ), high-frequency stimulation (≥ 5 Hz) induces excitatory effects, whereas low-frequency stimulation (≤ 1 Hz) results in inhibitory effects.…”

Section: Prevention Of Inpatient Suicide In Psychiatric Settingsmentioning

confidence: 99%

“…Serafini et al ( 284 ) conducted a systematic review of the literature to assess the association between rTMS and suicidal behavior. The majority of studies identified the l-DLPFC as the preferred area of stimulation.…”

Section: Prevention Of Inpatient Suicide In Psychiatric Settingsmentioning

confidence: 99%

“…DTMS was associated with improvements in behavior and suicidal ideation. Bilateral TMS was significantly more effective than placebo ( 290 , 293 ), and standard TMS was more effective in combination with antidepressant treatment ( 284 ). In the study by Croarkin et al ( 294 ), the reduction in suicidal risk was mediated by an improvement in depressive symptoms.…”

Section: Prevention Of Inpatient Suicide In Psychiatric Settingsmentioning

confidence: 99%

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Inpatient suicide in psychiatric settings: Evaluation of current prevention measures

2022

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The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.

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“…By comparing the effects of epilepsy treatment and non-invasive brain stimulation on suicide, Chen et al supported the effect of ECT on acute suicidal ideation, but they could not suggest the same for MST, rTMS, or tDCS ( 24 ). Bozzay et al review ( 25 ) supports the ongoing use of TMS as a new medium to reduce suicide risk; Serafini et al analyzed the relationship between rTMS interventions and suicidal behavior, one of multiple suicidal dimensions (e.g., suicidal ideation, intensity of suicidal thoughts, suicidal behavior, and suicidal intent), in a systematic study ( 26 ). A Meta-analysis ( 27 ) concluded that the efficacy and efficiency of high frequency was higher than that of the sham stimulation group; Brunoni et al ( 28 ) included nearly 100 studies and showed that low frequency stimulation was the most effective, while high frequency stimulation was the least effective, bilateral stimulation was intermediate, and bilateral stimulation and low frequency stimulation were the most acceptable of the stimulation modes; Dell'Osso et al ( 29 ) showed that high-frequency stimulation and low-frequency stimulation were similarly effective.…”

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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Effects of repetitive transcranial magnetic stimulation on suicidal behavior: A systematic review

Cited by 18 publications

References 49 publications

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Inpatient suicide in psychiatric settings: Evaluation of current prevention measures

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

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