Pubblicazioni

Bilateral Repetitive Transcranial Magnetic Stimulation Decreases Suicidal Ideation in Depression

CR, Weissman; DM, Blumberg; PE, Brown; M, Isserles; TK, Rajji; J, Downar; BH, Mulsant; PB, Fitzgerald; ZJ, Daskalakis

Abstract:

OBJECTIVE: The purpose of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on suicidal ideation in patients with treatment-resistant major depression (TRD) (patients who failed to clinically respond to at least 2 medication trials). METHODS: We pooled data from 2 published prospective randomized controlled trials of rTMS applied to the dorsolateral prefrontal cortex in patients with TRD. We compared the effect of bilateral, left unilateral, and sham rTMS on suicidal ideation as measured by the suicide item of the 17-item Hamilton Depression Rating Scale (HDRS) (N = 156). RESULTS: Suicidal ideation resolved in 40.4%, 26.8%, and 18.8% of participants randomized to bilateral, left unilateral, and sham rTMS, respectively. The difference between bilateral and sham was significant (OR = 3.03; 95% CI, 1.19-7.71; P = .02), unlike the difference between left unilateral and sham (OR = 1.59; 95% CI, 0.61-4.12; P = .33). There was a modest correlation between change in suicidal ideation and change in depression severity (Pearson r = 0.38; P < .001) and no difference in change of HDRS-16 score between suicide remitters and nonremitters (P = .32). CONCLUSIONS: Bilateral rTMS was superior to sham rTMS in reducing suicidal ideation in patients with TRD. Only a small portion of the reduction in suicidal ideation was attributable to the reduction in depressive symptoms. These data suggest that suicidal ideation could be a specific target symptom construct for rTMS.

Patologie/Applicazioni:

• Depressione
• Stimolazione Magnetica Transcranica (TMS)

Anno:

2018

Tipo di pubblicazione:

Articolo

Parola chiave:

suicidio; stimolazione magnetica transcranica; depressione; corteccia prefrontale

Testata scientifica:

The journal of clinical psychiatry

Nota:

Lo scopo di questo lavoro è la valutazione dell'effetto della stimolazione magnetica transcranica (rTMS) bi-emisferica sull'ideazione suicidaria in pazienti affetti da depressione. Sono stati messi a confronto dati relativi alla TMS bilaterale, TMS unilaterale e stimolazione sham, valutati con la scala Hamilton. I risultati suggeriscono che la rTMS bilaterale sia più efficace nel ridurrei pensieri legati al suicidio rispetto alla stimolazione Sham. I risultati mostrano che l'ideazione suicidaria può essere un sintomo suscettibile di trattamento con rTMS.

DOI:

10.4088/JCP.17m11692