Repetitive Transcranial Magnetic Stimulation Promotes Rapid Psychiatric Stabilization in Acutely Suicidal Military Service Members

Abstract

ObjectiveThis study presents data for using accelerated transcranial magnetic stimulation (TMS) as an intervention for suicidal crisis (SC).MethodsThis prospective, single-site, randomized, double-blind trial enrolled active-duty military participants with SC to receive either active TMS (n = 59) or sham TMS (n = 61) 3 times per day for 3 consecutive days. Our primary outcome, the Beck Scale for Suicidal Ideation—current (SSI-C), was measured before each session of TMS. Secondary outcomes measured both the SSI-C and the Beck Scale for Suicidal Ideation—total daily for the 3 intervention days and at 1, 3, and 6 months of follow-up.ResultsIn the modified intention to treat (mITT) analysis of SSI-C changes over treatment sessions, the TMS active group had accelerated decline in suicidal ideation as compared with sham: β for interaction was 0.12 points greater SSI-C decline per session (standard error [SE], 0.06) in TMS versus sham (P = 0.04). In both the mITT and per-protocol active TMS groups, the mean final SSI-C scores were below 3. These scores remained below 3 for the entire 6-month follow-up period.ConclusionsIn this military trial of suicidal patients, we found that both active and sham accelerated TMS rapidly reduces SC. Moreover, in the mITT analysis, there was a statistically significant antisuicidal benefit of active TMS versus sham TMS in the primary outcome. Both the mITT and per-protocol groups moved from higher to approximately 7 times lower suicide risk strata and remained there for the duration of the study. Further studies are warranted to understand accelerated TMS' full potential as a treatment for SC.

Editor's Roundup for Issue 2 of 2022

“…A rarer adverse effect of ECT is the occurrence of tardive seizure after the ECT session, and the impression of the rarity of this event is confirmed in this issue of the Journal by Warren et al 5 On a different note, although ECT is an acknowledged strategy to quiet suicidal ideation, [6][7][8][9] the corresponding literature on transcranial magnetic stimulation (TMS) and suicidal ideation has been sparse. Therefore, we welcome the randomized clinical trial by Hines et al 10 showing that intensive, thrice-daily TMS was superior to sham TMS in rapidly relieving acute suicidal ideation.…”