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

Abstract

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.

Suicidal risk is associated with hyper-connections between frontal-parietal and limbic networks in patients with depression

“…However, treatment response depends on selecting the precise therapeutic target or circuit. Beyond dorsolateral prefrontal cortex (DLPFC) TMS, limited evidence suggests that directly targeting the IPL could be therapeutically valuable in depressed patients with suicide ideation 37,38 . Network-based brain stimulation in the FPN and LMB may guide future therapies to enhance the antidepressant response, especially in patients at high risk of suicide.…”

Efficacy and Tolerability of Repetitive Transcranial Magnetic Stimulation on Suicidal Ideation: A Systemic Review and Meta-Analysis

“…Second, this study has several advantages over the most recent meta-analysis study (72). We included larger sample sizes (802 vs. 566) and a greater number of eligible studies (10 vs. 8) including three additional RCTs (43,44,47) and conducted a meta-regression and a subgroup analysis of TRD vs. non-TRD, which was considered as one of the limitations by Cui et al (72). Third, the present meta-analysis included high-quality RCTs with sham control, providing robust evidence of the efficacy of rTMS in reducing suicidal ideation.…”

“…The present study conducted a metaanalysis, meta-regression, and subgroup analysis to demonstrate the effect of rTMS on suicidality and explore potential sources of heterogeneity across studies. Second, this study has several advantages over the most recent meta-analysis study (72). We included larger sample sizes (802 vs. 566) and a greater number of eligible studies (10 vs. 8) including three additional RCTs (43,44,47) and conducted a meta-regression and a subgroup analysis of TRD vs. non-TRD, which was considered as one of the limitations by Cui et al (72).…”