Suizidalität bei Depressionen unter repetitiver transkranieller Magnetstimulation

Suicidality is a serious global public health problem and is closely associated with depression. There is a need for effective anti-suicidal therapies. rTMS shows promising potential as a modern form of therapy. Due to the still very limited evidence on this connection, there is a need for further research. Thus, the primary research objective of the present project was to investigate the effect of rTMS on suicidality in depressive patients. Two research questions were to be answered. Firstly, how the suicidality of test subjects changes after the intervention compared to the initial situation. Secondly, whether the use of rTMS shows greater anti-suicidal effectiveness than the use of conventional pharmacotherapy in a direct sample comparison. As part of a crossover study, a sample of 54 depressives underwent an iTBS intervention (5Hz trains with 50Hz bursts). The data was collected in clinical interviews using standardized measurement instruments. The suicidality of the participants was significantly reduced. However, there were no significant differences between the two study arms. In a similarly composed sample of 33 depressive subjects undergoing conventional antidepressant pharmacotherapy, a comparable anti-suicidal effect was shown. The secondary research objective of this project was to identify associations between an anti-suicidal treatment effect after rTMS intervention in depressive subjects deep clinical risk factors for suicidality. Lifetime suicidality (suicidal thoughts and behavior), certain sociodemographic characteristics (family status, income and social support) as well as anxiety, impulsivity and sleep disturbances were found to be potentially suitable factors. The analysis of the 54 depressive subjects undergoing rTMS therapy showed significant positive correlations between the reduction in suicidality and the reduction in impulsivity and sleep disorders, a trend towards a positive association with the reduction in anxiety and significant group differences according to income. Overall, the results of the present project showed a significant reduction in suicidality in depressive patients after rTMS intervention compared to the initial situation, which initially confirms the assumed potential for anti-suicidal effectiveness. However, this is put into perspective by the fact that the results did not allow a reliable differentiation from placebo effects, nor did the observed effect prove to be superior to that of conventional pharmacotherapy. Furthermore, the results obtained suggest that the change in impulsivity and sleep disturbances as well as possibly that of anxiety and income level with regard to the reduction of suicidality in depressive subjects undergoing rTMS therapy could be of clinical benefit. There is still a need for further research in this area. On one hand, in order to outline the anti-suicidal effectiveness of rTMS even more clearly in the future, and on the other hand, in order to be able to identify and specify further factors for estimating the success of therapy.