Modulation of suicide-related neural circuits by transcranial magnetic stimulation and its role in reducing suicide risk

Suicide remains a critical public health issue, frequently linked to dysfunction in specific neural circuits. Disruption of these circuits may contribute to the onset of suicide. Accordingly, this study investigates the therapeutic potential of transcranial magnetic stimulation (TMS) in modulating suicide-related damaged networks. A total of 473 major depressive disorder patients were included, comprising 369 suicidal and 104 non-suicidal individuals. Deviations in functional connectivity strength (FCS) within the suicide-related damaged network were calculated using a normative model based on 943 healthy controls. Suicidal patients showed significantly higher deviations within the suicide-related damaged network compared to non-suicidal patients (z = 3.02, p = 0.003). Following TMS treatment, the mean deviations significantly decreased (z = 2.23, p = 0.026), particularly in responders (z = 2.29, p = 0.020). Furthermore, a classifier based on these deviations predicted treatment response with an accuracy of 75% and an area under the curve of 0.72. These findings suggest that deviations in FCS may serve as a neural marker of suicide risk and a potential predictor of treatment response to TMS. TMS may reduce suicide risk by modulating neuroplasticity within the suicide-related damaged network.