The high-profile suicides of fashion designer Kate Spade and food journalist Anthony Bourdain in the space of a few days bring home the fact that deep depression is very hard to treat successfully. Each day, 123 people in the US take their own lives, on average. Many struggled with depression that simply didn’t respond to treatments, even to the most advanced antidepressant medications. But there’s new hope now because of a medical procedure that’s both painless and simple.
According to an analysis of two clinical trials published in The Journal of Clinical Psychiatry, repetitive transcranial magnetic stimulation, or rTMS, a type of brain stimulation using electromagnetic waves, can stop suicidal ideation—having thoughts of suicide, which is a precursor to suicide—in a significant number of people with major depression.
In this study, researchers analyzed the effect of rTMS on 156 people with major depression who had suicidal ideation and had failed to get better on at least two trials of antidepressant medications. Each participant was given one of the following—rTMS to both sides of the brain…rTMS to just the left side of the brain…or a treatment that looked like rTMS but did not actually give the stimulation (to test the placebo effect).
The findings: By the end of the study, thoughts of committing suicide were eliminated in 40% of those who received stimulation to both sides of the brain…27% who received stimulation to one side of the brain…and only 19% in the placebo group.
In other words, the success rate in the “both sides” group was twice as high as that in the placebo group and, at 40%, was quite high on an absolute basis as well.
Magnetic stimulation is a noninvasive procedure that is given through a device that’s placed on the head. Patients don’t need to be put to sleep or receive any drugs in conjunction with the treatment. Treatment is typically done five days a week for several weeks and takes about 30 minutes per session.
Although other treatments also may relieve suicidal ideation, rTMS has advantages over them. For instance, electroconvulsive therapy (ECT, or shock therapy) requires anesthesia and can cause memory loss, while the drug lithium can cause kidney damage. Researchers concluded that bilateral rTMS is a safe and effective alternative for treating suicidal ideation.
One particularly interesting finding was that rTMS stopped suicidal thoughts even when it didn’t relieve other signs or symptoms of depression such as feelings of sadness, anxiety and hopelessness. The theory is that it may work on an area of the brain specific to impulse control and suicidal ideation. It also may work for other mental health disorders in which suicide is a major risk, such as bipolar disorder, PTSD, schizophrenia and borderline personality disorder.
COULD YOU BE A CANDIDATE FOR rTMS?
To determine suicide risk, patients are asked the following questions…:
- Do you feel like life is not worth living?
- Do you wish you were dead or have thoughts of death?
- Do you have thoughts of suicide?
- Have you attempted suicide?
If you or someone you know could say “yes” to any of the first three questions or if there’s any chance that an attempted suicide was not based on factors that are now firmly in the past and done with, talk to your health-care provider right away about rTMS—it could be a lifesaver.
Note: In an emergency, call the National Suicide Prevention hotline at 1-800-273-8255.
