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

Guan-Wei Chen, Tien-Wei Hsu, Pao-Yuan Ching, Chih-Chuan Pan, Po-Han Chou, Che-Sheng Chu, Guan-Wei Chen, Tien-Wei Hsu, Pao-Yuan Ching, Chih-Chuan Pan, Po-Han Chou, Che-Sheng Chu

Abstract

Objective: This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating suicidal ideation in patients with mental illness.

Method: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major electronic databases were systematically searched from the time of their inception until July 22, 2021. The primary outcome was the mean change in the scores for suicidal ideation. The secondary outcome was the mean change in depression severity.

Results: Ten randomized controlled trials were eligible with 415 participants in the active treatment group (mean age = 53.78 years; mean proportion of women = 54.5%) and 387 participants in the control group (mean age = 55.52 years; mean proportion of women = 51.78%). rTMS significantly reduced suicidal ideation (k = 10, n = 802, Hedges' g = -0.390, 95% confidence interval [CI] = -0.193 to -0.588, p <.001) and severity of depressive symptoms (k = 9, n = 761, Hedges' g = -0.698, 95% CI = -1.023 to -0.372, p < 0.001) in patients with major mental disorders. In the subgroup analysis, rTMS reduced suicidal ideation among patients with non-treatment-resistant depression (non-TRD) (-0.208) but not in those with TRD. rTMS as combination therapy had a larger effect than did monotherapy (-0.500 vs. -0.210). Suicidal ideation significantly reduced in patients receiving more than ten treatment sessions (-0.255). Importantly, the rTMS group showed favorable tolerability without major adverse events.

Conclusion: The study showed that rTMS was effective and well-tolerated in reducing suicidal ideation and depression severity in patients with major mental disorders.

Keywords: bipolar disorder; borderline personality; depression; repetitive transcranial magnetic stimulation; suicidal ideation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Chen, Hsu, Ching, Pan, Chou and Chu.

Figures

Figure 1
Figure 1
Flow chart of the search strategy.
Figure 2
Figure 2
Forest plot of meta-analysis of improvement of suicidal ideation in patients receiving repetitive transcranial magnetic stimulation treatment and in those with control treatment.
Figure 3
Figure 3
(A) Forest plot of meta-analysis of improvement of suicidal ideation in patients with TRD receiving repetitive transcranial magnetic stimulation treatment and in those with control treatment. (B) forest plot of meta-analysis of improvement of suicidal ideation in patients with non-TRD receiving repetitive transcranial magnetic stimulation treatment and in those with control treatment.
Figure 4
Figure 4
(A) Forest plot of meta-analysis of improvement of suicidal ideation in patients receiving repetitive transcranial magnetic stimulation monotherapy and in those with control treatment. (B) forest plot of meta-analysis of improvement of suicidal ideation in patients receiving repetitive transcranial magnetic stimulation combination therapy and in those with control treatment.

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