Skip to main content
SpringerLink
Log in

Non-invasive Brain Stimulation in the Management of Suicidal Behavior

  • Published:
Current Behavioral Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The number of evidence supporting the use of various forms of non-invasive brain stimulation (NIBS) techniques for suicidal behavior is growing. This review updates the role of NIBS techniques in managing suicidal behavior based on recent evidence.

Recent Findings

Evidence showed that repetitive transcranial magnetic stimulation (rTMS) showed positive outcomes in reducing suicidal behavior. There is lack of rigorous clinical trial evidence on the usage of cranial electrotherapy stimulation (CES) and transcranial direct current stimulation (tDCS) in decreasing the risk of suicide.

Summary

It has been demonstrated that the rTMS is an effective alternative or supplemental treatment option for suicidal behavior. Suicide-specific CES and tDCS clinical trials are greatly needed. Future research is required to overcome methodological limitations and assess the long-term effectiveness of NIBS alone and in conjunction with medication and/or psychotherapy due to the inadequate quality and quantity of the included studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No datasets were generated or analyzed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. World Health Organization (WHO). Suicide worldwide in 2019: global health estimates. WHO; 2021. https://www.who.int/publications/i/item/9789240026643. Accessed 27 Jan 2024.

  2. Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psych. 2016;3(7):646–59.

    Article  Google Scholar 

  3. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30(1):133–54.

    Article  PubMed  Google Scholar 

  4. Favril L, Yu R, Uyar A, Sharpe M, Fazel S. Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. Evid Based Ment Health. 2022;25(4):148–55.

    Article  PubMed  PubMed Central  Google Scholar 

  5. World Health Organization. Preventing suicide: a global imperative. 2021. http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/. Accessed 27 Jan 2024.

  6. • Chen Y, Magnin C, Brunelin J, Leaune E, Fang Y, Poulet E. Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review. Brain Behav. 2021;11(5): e02144. (This systematic review assessed the role of seizure therapies [ECT, MST, rTMS, tDCS, and cranial electrostimulation] in suicide prevention. It discussed different modalities of seizures. It found that ECT was effective in preventing suicidal thoughts, suicide attempt, and suicide in different psychiatric morbidity in different schedule than pharmacotherapies alone. MST and rTMS have effects on reduction of suicidal thoughts. Only one study found tDCS’s preventing role suicidal thoughts.)

    Article  PubMed  PubMed Central  Google Scholar 

  7. Griffiths JJ, Zarate CA Jr, Rasimas JJ. Existing and novel biological therapeutics in suicide prevention. Am J Prev Med. 2014;47(3):S195-203.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Desmyter S, Duprat R, Baeken C, Van Autreve S, Audenaert K, van Heeringen K. Accelerated intermittent theta burst stimulation for suicide risk in therapy-resistant depressed patients: a randomized, sham-controlled trial. Front Hum Neurosci. 2016;10:480.

    Article  PubMed  PubMed Central  Google Scholar 

  9. •• Godi SM, Spoorthy MS, Purushotham A, Tikka SK. Repetitive transcranial magnetic stimulation and its role in suicidality–a systematic review. Asian J Psychiat. 2021;63: 102755. (This systematic review assessed the role of rTMS in suicidal behavior. The study assessed 20 studies with a sample of 1584. It discussed different modules of rTMS in different areas of the brain. It revealed a reduction of suicidal behavior with high-frequency rTMS given at the left dorsolateral prefrontal cortex in addition to antidepressant drugs among patients with treatment-resistant depressive disorders. It did not find any association with stimulation in other areas.)

    Article  Google Scholar 

  10. • Kucuker MU, Almorsy AG, Sonmez AI, Ligezka AN, Doruk Camsari D, Lewis CP, Croarkin PE. A systematic review of neuromodulation treatment effects on suicidality. Front Human Neurosci. 2021;15: 660926. (This recent systematic review assessed the role of neuromodulation in reducing suicidal behavior from 1940 to 2020 with 129 papers It showed positive effect of tDCS [with sertraline], rTMS, MST, ECT in reducing suicidal thoughts, and ECT in reducing suicide rates.)

    Article  Google Scholar 

  11. Taylor R, Galvez V, Loo C. Transcranial magnetic stimulation (TMS) safety: a practical guide for psychiatrists. Australas Psychiat. 2018;26(2):189–92.

    Article  Google Scholar 

  12. Pavlova EL, Menshikova AA, Semenov RV, Bocharnikova EN, Gotovtseva GN, Druzhkova TA, Gersamia AG, Gudkova AA, Guekht AB. Transcranial direct current stimulation of 20-and 30-minutes combined with sertraline for the treatment of depression. Prog Neuropsychopharmacol Biol Psych. 2018;82:31–8.

    Article  CAS  Google Scholar 

  13. Price L, Briley J, Haltiwanger S, Hitching R. A meta-analysis of cranial electrotherapy stimulation in the treatment of depression. J Psychiatr Res. 2021;135:119–34.

    Article  PubMed  Google Scholar 

  14. •• Sun Y, Blumberger DM, Mulsant BH, Rajji TK, Fitzgerald PB, Barr MS, Downar J, Wong W, Farzan F, Daskalakis ZJ. Magnetic seizure therapy reduces suicidal ideation and produces neuroplasticity in treatment-resistant depression. Trans Psych. 2018;8(1):253. (This trial provided MST in 23 patients with treatment-resistant depression (TRD) to assess the impact of MST on reduction of suicidal ideation. Among the 23 patients, 18 had suicidal ideation at the baseline. Suicidal thoughts were resolved in 44.4% [8 out of 18] patients, while no improvement was found in the rest 56.6% [10 out of 18].)

    Article  Google Scholar 

  15. Pinna M, Manchia M, Oppo R, Scano F, Pillai G, Loche AP, Salis P, Minnai GP. Clinical and biological predictors of response to electroconvulsive therapy (ECT): a review. Neurosci Lett. 2018;669:32–42.

    Article  PubMed  CAS  Google Scholar 

  16. • Liang CS, Chung CH, Ho PS, Tsai CK, Chien WC. Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression. Bipolar Disord. 2018;20(6):539–46. (This nationwide cohort study from Taiwan found that ECT showed potential anti-suicidal role in both unipolar and bipolar depression. However, it lacked any role supporting preventive role in suicide among patients with mania and mixed episodes.)

    Article  PubMed  CAS  Google Scholar 

  17. • Rönnqvist I, Nilsson FK, Nordenskjöld A. Electroconvulsive therapy and the risk of suicide in hospitalized patients with major depressive disorder. JAMA Netw Open. 2021;4(7): e2116589. (This cohort study from Sweden showed that ECT revealed anti-suicidal role among patients with severe depression with psychotic feature having age above 45 years.)

    Article  PubMed  PubMed Central  Google Scholar 

  18. • Park MJ, Kim H, Kim EJ, Yook V, Chung IW, Lee SM, Jeon HJ. Recent updates on electro-convulsive therapy in patients with depression. Psychiatry Investig. 2021;18(1):1–10. (This review assessed the role of ECT in the treatment of depression. It revealed supportive evidence for ECT as anti-suicidal role in severe depression with suicidal behavior.)

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jørgensen MB, Rozing MP, Kellner CH, Osler M. Electroconvulsive therapy, depression severity and mortality: data from the Danish National Patient Registry. J Psychopharmacol. 2020;34(3):273–9.

    Article  PubMed  Google Scholar 

  20. •• Bozzay ML, Primack J, Barredo J, Philip NS. Transcranial magnetic stimulation to reduce suicidality–a review and naturalistic outcomes. J Psychiatr Res. 2020;125:106–12. (This study assessed the role of rTMS on suicidal ideation. It found a reduction of depressive symptoms with rTMS and promising results for suicidal ideation. There are concerns about the study design and adequacy of sample to consider a precise association. Further well-designed studies are recommended using rTMS among patients with suicidal behavior.)

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin neurophysiol. 2009;120(12):2008–39. https://doi.org/10.1016/j.clinph.2009.08.016

  22. • Pan F, Li D, Wang X, Lu S, Xu Y, Huang M. Neuronavigation-guided high-dose repetitive transcranial magnetic stimulation for the treatment of depressive adolescents with suicidal ideation: a case series. Neuropsychiatr Dis Treat. 2018:2675–9. This case series reported three cases with severe major depressive disorder and suicidal ideations those were treated with pharmacotherapy and high-dose rTMS. The report revealed reduction of depression and suicidal ideation after high doses of rTMS.

  23. Perera T, George MS, Grammer G, Janicak PG, Pascual-Leone A, Wirecki TS. The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder. Brain Stimul. 2016;9(3):336–46.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rapinesi C, D Kotzalidis G, Scatena P, Del Casale A, Janiri D, Callovini G, Piacentino D, Serata D, N Raccah R, Brugnoli R, Digiacomantonio V. Alcohol and suicidality: could deep transcranial magnetic stimulation (dTMS) be a possible treatment?. Psy Danubina. 2014;26(3):281–4.

  25. •• George MS, Raman R, Benedek DM, Pelic CG, Grammer GG, Stokes KT, Schmidt M, Spiegel C, DeAlmeida N, Beaver KL, Borckardt JJ. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. Brain Stimul. 2014;7(3):421–31. (This sham control randomized trail assessed the efficacy of high dose intense rTMS among hospitalized patients with suicidal behavior. It revealed high-dose intense rTMS is safe, feasible, and effective in suicide reduction with minimal side effects.)

    Article  PubMed  Google Scholar 

  26. •• Dai L, Wang P, Zhang P, Guo Q, Du H, Li F, He X, Luan R. The therapeutic effect of repetitive transcranial magnetic stimulation in elderly depression patients. Med. 2020;99(32), e21493. This randomized sham control study found that along with pharmacotherapy, rTMS showed effect in reducing depressive symptoms and suicidal behavior among the elderly patients.

  27. •• Qin BY, Dai LL, Zheng Y. Efficacy of repetitive transcranial magnetic stimulation for alleviating clinical symptoms and suicidal ideation in elderly depressive patients: a randomized controlled trial. Nan Fang yi ke da xue xue bao= J Southern Med Univ. 2017;37(1):97–101.This randomized sham control study found that along with pharmacotherapy, rTMS showed effect in reducing suicidal ideation and improving cognition, sleep quality, and somatic symptoms among the elderly patients with depression and suicidal ideation.

  28. Rao V, Bechtold K, McCann U, Roy D, Peters M, Vaishnavi S, Yousem D, Mori S, Yan H, Leoutsakos J, Tibbs M. Low-frequency right repetitive transcranial magnetic stimulation for the treatment of depression after traumatic brain injury: a randomized sham-controlled pilot study. J Neuropsychiatry Clin Neurosci. 2019;31(4):306–18.

    Article  PubMed  Google Scholar 

  29. •• Weissman CR, Blumberger DM, Brown PE, Isserles M, Rajji TK, Downar J, Mulsant BH, Fitzgerald PB, Daskalakis ZJ. Bilateral repetitive transcranial magnetic stimulation decreases suicidal ideation in depression. J Clin Psychiatry. 2018;79(3):5831. This study assessed the role of rTMS in reducing suicidality among patients with TRD and suicidal ideation. It showed that bilateral rTMS is superior in reducing suicidal ideation than the controls.

  30. Fitzgerald PB, Hoy KE, Elliot D, Susan McQueen RN, Wambeek LE, Daskalakis ZJ. Accelerated repetitive transcranial magnetic stimulation in the treatment of depression. Neuropsychopharmacol. 2018;43(7):1565–72.

    Article  Google Scholar 

  31. Keshtkar M, Ghanizadeh A, Firoozabadi A. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for the treatment of major depressive disorder, a randomized controlled clinical trial. J ECT. 2011;27(4):310–4.

    Article  PubMed  Google Scholar 

  32. Calderón-Moctezuma AR, Reyes-López JV, Rodríguez-Valdés R, Barbosa-Luna M, Ricardo-Garcell J, Espino-Cortés M, Hernández-Chan N, García-Noguez L, Roque-Roque G, Trejo-Cruz G, Cañizares-Gómez S. Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results. Braz J Psych. 2020;43:65–9.

    Article  Google Scholar 

  33. Yesavage JA, Fairchild JK, Mi Z, Biswas K, Davis-Karim A, Phibbs CS, Forman SD, Thase M, Williams LM, Etkin A, O’Hara R. Effect of repetitive transcranial magnetic stimulation on treatment-resistant major depression in US veterans: a randomized clinical trial. JAMA Psychiat. 2018;75(9):884–93.

    Article  Google Scholar 

  34. •• Cui Y, Fang H, Bao C, Geng W, Yu F, Li X. Efficacy of transcranial magnetic stimulation for reducing suicidal ideation in depression: a meta-analysis. Front Psychiat. 2022;12:764183. This meta-analysis assessed the efficacy of TMS in reducing suicidality among patients with depression and suicidal ideation. It found that TMS significantly reduces suicidal ideations and improved the quality of life.

  35. •• Mehta S, Konstantinou G, Weissman CR, Daskalakis ZJ, Voineskos D, Downar J, Mulsant BH, Blumberger DM. The effect of repetitive transcranial magnetic stimulation on suicidal ideation in treatment-resistant depression: a meta-analysis. J Clin Psych. 2022;83(2): 21r13969 This meta-analysis assessed the efficacy of rTMS in reducing suicidality among patients with TRD. It found that rTMS was effective in treatment suicidal ideation in TRD.

  36. •• Serafini G, Canepa G, Aguglia A, Amerio A, Bianchi D, Magnani L, Dell'Osso B, Pompili M, Fitzgerald PB, Amore M. Effects of repetitive transcranial magnetic stimulation on suicidal behavior: a systematic review. Prog Neuropsychopharmacol Biol Psych. 2021;105:109981. This systematic review assessed the efficacy of rTMS in reducing suicidality among patients with depression. It found that rTMS was safe, effective in treatment suicidal ideation in depression along with pharmacotherapy.

  37. •• Chen GW, Hsu TW, Ching PY, Pan CC, Chou PH, Chu CS. Efficacy and tolerability of repetitive transcranial magnetic stimulation on suicidal ideation: a systemic review and meta-analysis. Front Psychiat. 2022;13:884390. This systematic review and meta-analysis assessed the efficacy and tolerability of rTMS in reducing suicidal ideation. It found that rTMS was safe and effective in reducing suicidal ideation and depression along with pharmacotherapy.

  38. •• Wang Q, Huang H, Li D, Wang Y, Qi N, Ci Y, Xu T. Intensive rTMS for treatment-resistant depression patients with suicidal ideation: An open-label study. Asian J psychiat. 2022;74:103189. This open level study assessed intense rTMS in reducing suicidal ideation in TRD. It found intense rTMS could be effective more than conventional rTMS.

  39. •• Barredo J, Berlow Y, Swearingen HR, Greenberg BD, Carpenter LL, Philip NS. Multimodal elements of suicidality reduction after transcranial magnetic stimulation. Neuromodulation. 2021;24(5):930–937. This study assessed different modules of rTMS among patients with PTSD and depression. It found reduction suicidal thoughts among 65% of patients.

  40. Rangarajan SK, Suhas S, Reddy MS, Sreeraj VS, Sivakumar PT, Venkatasubramanian G. Domiciliary tDCS in geriatric psychiatric disorders: opportunities and challenges. Ind J Psychol Med. 2021;43(4):351–6.

    Article  Google Scholar 

  41. Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments Canadian J Psych. 2016;61(9):561–75.

    Google Scholar 

  42. Batsikadze G, Moliadze V, Paulus W, Kuo MF, Nitsche M. Partially non-linear stimulation intensity-dependent effects of direct current stimulation on motor cortex excitability in humans. J Physiol. 2013;591(7):1987–2000.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Chen Y, Lyu D, Wang F, Huang Q, Yang W, Zhang M, Wei Z, Shi S, Kong S, Chen S, He S. Adjunctive duration-doubled transcranial direct current stimulation for the treatment of depressive patients with suicidal ideation: study protocol for a double-blind, randomized, sham-controlled trial. Trials. 2024;25(1):15.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Herrera-Melendez AL, Bajbouj M, Aust S. Application of transcranial direct current stimulation in psychiatry. Neuropsychobiol. 2020;79(6):372–83.

    Article  Google Scholar 

  45. Ciullo V, Spalletta G, Caltagirone C, Banaj N, Vecchio D, Piras F, Piras F. Transcranial direct current stimulation and cognition in neuropsychiatric disorders: systematic review of the evidence and future directions. Neuroscientist. 2021;27(3):285–309.

    Article  PubMed  CAS  Google Scholar 

  46. Chen Y, Wu C, Lyu D, Wang F, Huang Q, Yang W, Huang H, Zhang M, Zhou N, Wei Z, Shi S. Comparison of 60-minute vs 30-minute transcranial direct current stimulation (tDCS) in major depressive disorder: effects on depression suicidal ideation and anxiety. Psychiat Res. 2023;330: 115556.

    Article  Google Scholar 

  47. Price L, Briley J, Haltiwanger S, Hitching R. A meta-analysis of cranial electrotherapy stimulation in the treatment of depression. J Psychiatr Res. 2021;135:119–34.

    Article  PubMed  Google Scholar 

  48. Van Rooij SJ, Riva-Posse P, McDonald WM. The efficacy and safety of neuromodulation treatments in late-life depression. Curr Treatment Opt Psych. 2020:337–48. https://doi.org/10.1007/s40501-020-00216-w

  49. Ching PY, Hsu TW, Chen GW, Pan CC, Chu CS, Chou PH. Efficacy and tolerability of cranial electrotherapy stimulation in the treatment of anxiety: a systemic review and meta-analysis. Front Psychiat. 2022;13: 899040.

    Article  Google Scholar 

  50. Lee M, Kim Y, Yoon IY, Hong JK. Effects of cranial electrotherapy stimulation on improving depressive symptoms in people with stress: a randomized, double-blind controlled study. J Affect Dis. 2023;340:835–42.

    Article  PubMed  Google Scholar 

  51. Kayser S, Bewernick BH, Matusch A, Hurlemann R, Soehle M, Schlaepfer TE. Magnetic seizure therapy in treatment-resistant depression: clinical, neuropsychological and metabolic effects. Psychol Med. 2015;45(5):1073–92.

    Article  PubMed  CAS  Google Scholar 

  52. •• Weissman CR, Blumberger DM, Dimitrova J, Throop A, Voineskos D, Downar J, Mulsant BH, Rajji TK, Fitzgerald PB, Daskalakis ZJ. Magnetic seizure therapy for suicidality in treatment-resistant depression. JAMA Netw Open. 2020;3(8): e207434. (It is a nonrandomized control trial assessing the effectiveness of MST in reducing suicidality among patients with TRD. It found reduction of suicidal ideation in about 48% of the patients and suggested that MST could be an effective treatment option for suicidal ideation in TRD.)

    Article  PubMed  PubMed Central  Google Scholar 

  53. Daskalakis ZJ, Dimitrova J, McClintock SM, Sun Y, Voineskos D, Rajji TK, Goldbloom DS, Wong AH, Knyahnytska Y, Mulsant BH, Downar J. Magnetic seizure therapy (MST) for major depressive disorder. Neuropsychopharmacol. 2020;45(2):276–82.

    Article  Google Scholar 

  54. Tang VM, Blumberger DM, Hill AT, Weissman CR, Voineskos D, Rajji TK, Downar J, Knyahnytska Y, Mulsant BH, Fitzgerald PB, Daskalakis ZJ. Magnetic seizure therapy for the treatment of suicidality in bipolar depression. Biol Psychiat. 2021;90(10):e51–3.

    Article  PubMed  Google Scholar 

  55. Traynor JM, Ruocco AC, McMain SF, Hermanto N, Blumberger DM, Cardish R, Daskalakis Z. A feasibility trial of conjoint magnetic seizure therapy and dialectical behavior therapy for suicidal patients with borderline personality disorder and treatment-resistant depression. Nat Mental Health. 2023;1(1):45–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Bangladesh Specialized Hospital Limited, Dhaka, 1207, Bangladesh

    S. M. Yasir Arafat

  2. Department of Psychology, International Islamic University, Islamabad, Pakistan

    Syeda Ayat-e-Zainab Ali

Authors
  1. S. M. Yasir Arafat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Syeda Ayat-e-Zainab Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SAr and SAl wrote the main manuscript. All authors reviewed the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to S. M. Yasir Arafat.

Ethics declarations

Competing interests

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Conflict of Interest

None declared.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arafat, S.M.Y., Ali, S.AeZ. Non-invasive Brain Stimulation in the Management of Suicidal Behavior. Curr Behav Neurosci Rep (2024). https://doi.org/10.1007/s40473-024-00276-9

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40473-024-00276-9

Keywords

Search

Navigation