Citation

Serafini G, Canepa G, Aguglia A, Amerio A, Bianchi D, Magnani L, Dell'osso B, Pompili M, Fitzgerald PB, Amore M. Prog. Neuropsychopharmacol. Biol. Psychiatry 2021; 105: e109981.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.pnpbp.2020.109981

PMID

32485190

Abstract

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.

Language: en

Keywords

Humans; Treatment Outcome; Suicidal Ideation; Suicide, Attempted; Suicidal behavior; Transcranial Magnetic Stimulation; Major depression; Depressive Disorder, Major; Prefrontal Cortex; Brain-derived neurotrophic factor; rTMS; Left dorsolateral prefrontal cortex