rTMS and Suicidality in Adulthood; An Exploratory Open-Labeled Neuromodulative Approach to Battle Suicide

Abstract Background: Suicidal attempts are one of the most critical issues with a huge burden on family and health systems all around the world. To decrease the hazardous outcomes of this issue, mental health systems are trying to apply the most effective and safe interventions. In this regard, repetitive Transcranial Magnetic Stimulation (rTMS ) as a non-invasive approach could be a proper treatment approach. We investigated the impact of rTMS method on the treatment of the patients with suicidal ideation. For this purpose, the application of rTMS when integrating with Low-Resolution Electromagnetic Tomography (LORETA) data has been assessed.Methods: As an open-labeled study we enrolled 7 adult men who were recently rescued from suicidal attempts and referred to our psychiatric clinic for three consecutive months (2018). The severity of suicidal ideation was measured by the Beck Scale of Suicidal Ideation (SSI) and brain activity via Low-Resolution Electromagnetic Tomography (LORETA), administered at baseline and the end of the treatment course. Repetitive TMS was delivered to the left and right dorsolateral prefrontal cortices (DLPFC) with a figure-eight solid core coil at 110% motor threshold, 10 Hertz (Hz) and 4 second (s) train duration, (3000 pulses) (total 12 sessions; 36,000 stimuli). Six sessions daily and six sessions within two weeks were scheduled.Results: According to the results of psychiatric re-interview, LORETA, and SSI scores of all patients revealed an impressive and statistically significant decrease in suicidal ideation. No side effects were seen during the treatment course.Conclusions: Scheduled three consecutive weeks rTMS course was significantly effective in remitting acute suicidal ideation in adult men regardless of psychiatric diagnosis. Larger double-blinded studies must be conducted to validate the clinical usage of this safe and non-invasive treatment approach in the area of psychiatry.