High doses of repetitive transcranial magnetic stimulation (rTMS) to the left prefrontal cortex of the brains of suicidal inpatients reduced suicidal thoughts by half after just one day of treatment, according to a study published in Brain Stimulation.
Researchers tested the potential acute care treatment for suicidality on veterans in suicidal crisis at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina, and the Walter Reed National Military Medical Center in Bethesda, Maryland.
Prompted by the FDA’s recent approval of rTMS to the left prefrontal cortex at lower doses to treat acute depression, researchers conducted the study to determine whether a more intense treatment regimen might be feasible for inpatient suicidality.
“One of our goals was to show that the higher doses were safe, and we were able to do that here,” said researcher Mark George, MD, of the department of psychiatry and behavioral sciences at the Medical University of South Carolina, Charleston.
Dr. George and colleagues identified 41 inpatients, all of whom had post-traumatic stress disorder or mild traumatic brain injury and were in suicidal crisis, and administered heavy doses of rTMS to half and sham rTMS to the remaining participants. Patients received 6,000 pulses to the left prefrontal cortex for 30 minutes, three times a day, over three days. The sham rTMS device, however, featured a metal insert that blocked the device’s magnetic field.
All patients in the study continued their previously prescribed anti-suicidal treatments during the three-day investigation.
The accelerated schedule, researchers determined, is feasible, safe, and seemingly effective. After one day of treatment, active rTMS recipients showed rapid declines of scores on the Beck Scale of Suicidal Ideation (a 10.7 point decrease vs. 6.4 points), investigators reported. After three days, they reported a greater drop in “being bothered by thoughts of suicide” ratings than sham rTMS recipients. In addition, at six-month follow-up none of the patients had died by suicide.
The next step, researchers said, is to replicate results with a larger study population.
1. George MS, Raman R, Benedek DM, et al. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. Brain Stimulation. 2014 May-June; 7(3):421-31.