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

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 105; p. 109981
• Main Authors: Serafini, Gianluca, Canepa, Giovanna, Aguglia, Andrea, Amerio, Andrea, Bianchi, Davide, Magnani, Luca, Dell'Osso, Bernardo, Pompili, Maurizio, Fitzgerald, Paul B., Amore, Mario
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 08-03-2021
• Subjects: Brain-derived neurotrophic factor; Depressive Disorder, Major - physiopathology; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Humans; Left dorsolateral prefrontal cortex; Major depression; Prefrontal Cortex - physiopathology; rTMS; Suicidal behavior; Suicidal Ideation; Suicide, Attempted - psychology; Transcranial Magnetic Stimulation; Treatment Outcome; Left dorsolateral prefrontal cortex; Suicidal behavior; Brain-derived neurotrophic factor; Major depression; rTMS
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2020.109981

The efficacy and tolerability of repetitive transcranial magnetic stimulation (rTMS) in major depression is well-known and documented by existing studies. However, whether rTMS may be effective on suicidal behavior is unclear and needs to be further investigated. This systematic review is aimed to investigate the available literature about the effects of rTMS on suicidal behavior and provide a comprehensive overview of the available evidence. A systematic search regarding the association between rTMS and suicidal behavior was carried out. All relevant articles concerning this association were comprehensively searched on PubMed, Scopus, Science Direct, and PsycInfo databases. After a careful search, 16 articles (7 sham-controlled studies, 5 uncontrolled studies, 4 case-series) met inclusion criteria and were selected in this systematic review. Overall, the left dorsolateral prefrontal cortex (DLPFC) was identified as the most frequent stimulation target by most studies. Unfortunately, actually it is not clear whether suicidal behavior reduction may be mediated, at least in some cases, by depression attenuation. While some methodological heterogeneity was found in terms of stimulation parameters (e.g., frequency, number of sessions, intensity of stimulation), most of the analyzed articles showed that rTMS is a safe, applicable, well tolerated and reproducible method in treating suicidal behavior. The most effective treatment seems to be the bilateral rTMS as well as the combination with antidepressants. Further longitudinal studies are required in order to replicate the mentioned study results.
•rTMS is effective, globally safe, and well-tolerated in treating suicidal behavior.•DLPFC was identified as the most frequent stimulation brain region in suicidal patients.•Bilateral TMS is more effective in reducing suicide risk in combination with antidepressants.