S J Manuele, A Cerins, L M Jenkins, E H X Thomas, N Sabetfakhri, E Cholakians, A L Aaronson, L Chen
Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Psychiatry and Behavioral Sciences, Stephen M. Stahl Center for Psychiatric Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
medRxiv. 2025 May 6:2025.05.05.25327034. doi: 10.1101/2025.05.05.25327034.
Suicidal thoughts and behaviors (STB) have a substantial global burden, with over 14 million individuals attempting suicide annually. Existing biological therapies do not adequately reduce STB risk. Repetitive transcranial magnetic stimulation (rTMS) is an approved, non-invasive and low-risk treatment for several psychiatric disorders. Meta-analyses investigating TMS' effects on STB indicate therapeutic promise. Given the proliferation of TMS studies investigating its effect on STB, a repeat review of the literature is warranted.
A PRISMA-guided systematic review was conducted to evaluate the efficacy of rTMS in reducing STB. Studies assessing STB outcomes following rTMS to treat psychiatric disorders, either as monotherapy or adjunctive treatment, were included. Forty-five studies were identified (=3515).
Studies generally applied rTMS to treat primary psychiatric disorders, particularly depression, with change in suicidality evaluated as a secondary outcome. rTMS protocols differed across studies. Most studies targeted the left dorsolateral prefrontal cortex (dlPFC), although significant improvements to STB were also reported with rTMS targeting the visual cortex, right dlPFC and the bilateral PFC. High frequency rTMS and intermittent theta burst stimulation (iTBS) protocols were superior in reducing STB compared to other stimulation protocols, with studies reporting 40-100% treatment response rates. Adverse events (AEs) were mostly mild and transient.
rTMS appears to be a safe and effective treatment option for STB, with significant reductions observed, particularly when rTMS or iTBS is applied to the dlPFC. Mechanistically informed randomized controlled trials specifically designed to evaluate rTMS' treatment effects on STB are needed to validate this promising treatment approach.
自杀念头和行为（STB）在全球造成了沉重负担，每年有超过1400万人试图自杀。现有的生物疗法并不能充分降低STB风险。重复经颅磁刺激（rTMS）是一种已获批准的、非侵入性且低风险的治疗多种精神疾病的方法。调查TMS对STB影响的荟萃分析显示出治疗前景。鉴于研究TMS对STB影响的研究不断增多，有必要对文献进行再次综述。
进行了一项遵循PRISMA指南的系统综述，以评估rTMS在降低STB方面的疗效。纳入了评估rTMS治疗精神疾病（作为单一疗法或辅助治疗）后STB结果的研究。共识别出45项研究（n = 3515）。
研究通常将rTMS用于治疗原发性精神疾病，尤其是抑郁症，自杀倾向的变化作为次要结果进行评估。不同研究的rTMS方案各不相同。大多数研究针对左侧背外侧前额叶皮质（dlPFC），不过也有报道称，针对视觉皮质、右侧dlPFC和双侧PFC进行rTMS时，STB也有显著改善。与其他刺激方案相比，高频rTMS和间歇性theta爆发刺激（iTBS）方案在降低STB方面更具优势，研究报告的治疗有效率为40 - 100%。不良事件（AE）大多轻微且短暂。
rTMS似乎是一种安全有效的STB治疗选择，观察到有显著降低，尤其是当rTMS或iTBS应用于dlPFC时。需要专门设计用于评估rTMS对STB治疗效果的基于机制的随机对照试验，以验证这种有前景的治疗方法。
