| Paper Authors: | Denghuang Zhan, Elizabeth C. Gregory, Afifa Humaira, Hubert Wong, E. David Klonsky, Alexander Levit, Lisa Ridgway, Fidel Vila-Rodriguez |
| Post Author(s): | Alice Erchov |
| Download the research article: | Zhan et al., 2024: Trajectories of suicidal ideation during rTMS for treatment-resistant depression.pdf |
Introduction
Repetitive Transcranial Magnetic Stimulation (rTMS) therapy has been found to be a non-invasive, safe, and effective way of treating depression – even in individuals who do not respond to usual antidepressant medications. rTMS works by delivering a series of magnetic pulses that alter brain activity thought to be disrupted in depression.
Methods
In this study, 55 participants received rTMS every weekday for 4 weeks (a total of 20 treatments). Everybody completed a scale where they rated their level of suicidal ideation and negative (depressive) mood at the beginning and the end of treatment. These were analyzed to see how mood and suicidal ideation changed from rTMS and what factors might be related to treatment response.
Results
- It was found that, on average, participants’ suicidal ideation reduced by 1/3rd. They also had a 30% decrease in negative mood. A majority (60%) of participants had less suicidal ideation after rTMS, while 53% had improvements in their mood.
- Participants were more likely to improve on both mood and suicidal ideation (45%) or neither (33%) than either one on its own. About 22% of people had a “mismatch” response, where 15% saw improvement on suicidal ideation but not mood, and 7% responded had improved mood but not less suicidal ideation.
- Participants were more likely to not see improvements in suicidal ideation if they were male, had higher levels of anxiety before the start of treatment, or had high suicidal ideation before treatment. Participants with high levels of anxiety or were on benzodiazepine medication (e.g. lorazepam/Ativan) were less likely to see improvements in mood.
Conclusion
On average, participants saw less suicidal ideation and better mood after rTMS – even after they had not responded to classic antidepressant medication. Nobody’s mood or ideation was worsened after rTMS. We also saw that mood and suicidal ideation might be two separable concepts, since it was possible to improve in one or the other, without necessarily an improvement in both. These results support the use of rTMS as a safe and effective treatment for depression and helps us understand who might benefit the most.