Journal: AIMS Neuroscience (2025)
Authors: Iannuzzo F, Turiaco F, Messina V, Minutoli AM, Silvestri MC, Muscatello MRA, Bruno A.
Background:
Data suggests that the available therapeutic tools are still insufficient to deal with suicidality. Non-Invasive Brain Stimulation techniques (NIBS) have entered the recognized guidelines for therapies in psychiatry due to the advantages related to safety and tolerability.
Objective:
The purpose of this review and meta-analysis was to assess if and how NIBS techniques are used and could be effective in the treatment of suicidal ideation.
Methods:
The search included the Scopus, Pubmed, and Web of Science databases. The word “suicide” was combined with “NIBS”, “transcranial magnetic stimulation” (TMS), “deep TMS” and “transcranial direct current stimulation”.
Results:
Nine studies met the inclusion criteria and were included in the review. High frequency repetitive TMS (rTMS) protocols were associated with a significant reduction in suicidal ideation, with individual studies reporting improvements ranging from 20% to over 35% on scales such as the scale for suicide ideation (SSI) and the Beck scale of suicide ideation (BSI) (p < 0.01; p < 0.01; p < 0.001). The meta-analysis showed that active rTMS significantly reduced suicidal ideation compared to sham control conditions (Z = 16.79, p < 0.0001). Heterogeneity was high (I² = 99%, chi-square = 473.22, df = 3, p < 0.0001). High frequency rTMS protocols appeared most effective; deep TMS (dTMS) showed mixed results, and only one study utilized transcranial direct current stimulation (tDCS). Due to limited data, no meta-analysis was conducted on dTMS or tDCS studies.
Conclusions:
Although preliminary findings suggest a potential for NIBS techniques to reduce suicidal ideation, the current evidence is limited by the small number of high-quality studies and heterogeneity in the protocols and outcomes. Therefore, conclusions regarding clinical efficacy should be considered tentative.
