In our latest expert TMS blog, Smart TMS Technician Ailish O’Grady looks into suicide prevention treatments and the potential role of Transcranial Magnetic Stimulation Therapy.

Ailish writes:

According to the World health Organisation over 800,000 people die by suicide each year and the number of suicide attempts is estimated at approximately 20 times higher (WHO report, 2014). 

In the UK and Ireland 6,213 people have taken their own lives in 2017 alone. Suicide has become a major public health concern which effects people from all genders, age groups, backgrounds, ethnicities and sexualities.

Suicide is often uncomfortable for us to process and to speak about in our communities, however, as Sandler aptly phrases it “Suicide is like a pebble in a pond, the waves ripple outwards.”  The devastation of a suicide affects the individual, their family and friends and the wider community, so addressing this mental health issue is of utmost importance.

Current Suicide Prevention Treatments

Over the past five decades, governments worldwide have invested heavily in research studies and resources to investigate the most effective therapies and medications for treatment of suicidality. The efficacy of current available treatments is not entirely compelling and brings with them serious side effects, and the rates of suicide each year remain largely unchanged.

However, a new avenue of suicide prevention treatment has emerged in the form of Transcranial Magnetic Stimulation (TMS). From preliminary studies, this new alternative therapy appears promising in not only reducing suicidality but treating underlying psychiatric disorders also.

Current treatments available for individuals at risk of suicide include antidepressants, anti-psychotics, Lithium, Clozapine electroconvulsive therapy and various kinds of psychotherapies. However, lithium and clozapine have been found to cause serious and burdening side effects, which decreases likelihood of the application of these medications to wider populations.

While antidepressant and antipsychotic medications are commonly prescribed by GPs to people experiencing suicidal thoughts and/or psychiatric disorders such as depression and anxiety, there is uncertainty in relation to the effect these medications have on suicidal ideation specifically (Ciprani et al., 2016). In fact, some medications have been discovered to increase suicidal thoughts in certain subgroups eg. Youth, individuals with Bipolar disorder (Zimmerman et al., 2002; Isacsson, Holmgren, Ösby & Ahlner, 2009).

Furthermore, it can take up to weeks or months to determine the optimal dose and blend of these medications, in the meantime, the person remains at serious risk of suicide.

In a similar sense, while various types of therapy have been found to be extremely useful in treating psychiatric disorders, it can take anywhere from a few weeks to months to reap the psychological benefits of psychotherapy, concurrently leaving a person at risk of dying by suicide.

While electroconvulsive therapy has been shown to reduce suicidality, due to the treatment side effects, participant’s low-tolerance, high-cost and associated stigma, it is not widely used.

Future Suicide Interventions

In order to tackle this on-going widespread issue of suicide, alternative well-tolerated, effective and efficient interventions that rapidly reduce suicidality should be researched.

Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique which uses electromagnetic induction to stimulate the cerebral cortex. Repetitive TMS can modify the excitability of the cerebral cortex at targeted sites that are affected by psychiatric disorders such as depression, OCD anxiety among others.

The existing studies on the effect of TMS on Suicidality are:

Croarkin, P., Nakonezny, P., Deng, Z., Romanowicz, M., Voort, J., & Camsari, D. et al. (2018). High-frequency repetitive TMS for suicidal ideation in adolescents with depression. Journal Of Affective Disorders, 239, 282-290. doi: 10.1016/j.jad.2018.06.048

Desmyter, S., Duprat, R., Baeken, C., Van Autreve, S., Audenaert, K., & van Heeringen, K. (2016). Accelerated Intermittent Theta Burst Stimulation for Suicide Risk in Therapy-Resistant Depressed Patients: A Randomized, Sham-Controlled Trial. Frontiers In Human Neuroscience, 10. doi: 10.3389/fnhum.2016.00480

George, M., Raman, R., Benedek, D., Pelic, C., Grammer, G., & Stokes, K. et al. (2014). A Two-site Pilot Randomized 3 Day Trial of High Dose Left Prefrontal Repetitive Transcranial Magnetic Stimulation (rTMS) for Suicidal Inpatients. Brain Stimulation, 7(3), 421-431. doi: 10.1016/j.brs.2014.03.006

Pan, F., Li, D., Wang, X., Lu, S., Xu, Y., & Huang, M. (2018). Neuronavigation-guided high-dose repetitive Transcranial Magnetic Stimulation for the treatment of depressive adolescents with suicidal ideation: a case series. Neuropsychiatric Disease And Treatment, Volume 14, 2675-2679. doi: 10.2147/ndt.s176125

Weissman, C., Blumberger, D., Brown, P., Isserles, M., Rajji, T., & Downar, J. et al. (2018). Bilateral Repetitive Transcranial Magnetic Stimulation Decreases Suicidal Ideation in Depression. The Journal Of Clinical Psychiatry, 79(3). doi: 10.4088/jcp.17m11692

Agarwal, S., & McMullen, R. (2016). Successful treatment of bipolar disorder patients with Transcranial Magnetic Stimulation. Brain Stimulation, 9(5), e7-e8. doi: 10.1016/j.brs.2016.06.024

Chesney, E., Goodwin, G., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160. doi: 10.1002/wps.20128

Cipriani, A., Furukawa, T., Salanti, G., Chaimani, A., Atkinson, L., & Ogawa, Y. et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366. doi: 10.1016/s0140-6736(17)32802-7

George, M., Lisanby, S., Avery, D., McDonald, W., Durkalski, V., & Pavlicova, M. et al. (2010). Daily Left Prefrontal Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder. Archives Of General Psychiatry, 67(5), 507. doi: 10.1001/archgenpsychiatry.2010.46

George, M., Raman, R., Benedek, D., Pelic, C., Grammer, G., & Stokes, K. et al. (2014). A Two-site Pilot Randomized 3 Day Trial of High Dose Left Prefrontal Repetitive Transcranial Magnetic Stimulation (rTMS) for Suicidal Inpatients. Brain Stimulation, 7(3), 421-431. doi: 10.1016/j.brs.2014.03.006

Gorelick, D., Zangen, A., & George, M. (2014). Transcranial magnetic stimulation in the treatment of substance addiction. Annals Of The New York Academy Of Sciences, n/a-n/a. doi: 10.1111/nyas.12479

Hawton, K., & van Heeringen, K. (2009). Suicide. The Lancet, 373(9672), 1372-1381. doi: 10.1016/s0140-6736(09)60372-x

Isacsson, G., Holmgren, A., Ösby, U., & Ahlner, J. (2009). Decrease in suicide among the individuals treated with antidepressants: a controlled study of antidepressants in suicide, Sweden 1995-2005. Acta Psychiatrica Scandinavica, 120(1), 37-44. doi: 10.1111/j.1600-0447.2009.01344.x

Mantovani, A., Aly, M., Dagan, Y., Allart, A., & Lisanby, S. (2013). Randomized sham controlled trial of repetitive Transcranial Magnetic Stimulation to the dorsolateral prefrontal cortex for the treatment of panic disorder with comorbid major depression. Journal Of Affective Disorders, 144(1-2), 153-159. doi: 10.1016/j.jad.2012.05.038

Martin-Soelch, C. (2009). Is depression associated with dysfunction of the central reward system?. Biochemical Society Transactions, 37(1), 313-317. doi: 10.1042/bst0370313

McGirr, A., Van den Eynde, F., Tovar-Perdomo, S., Fleck, M., & Berlim, M. (2015). Effectiveness and acceptability of accelerated repetitive Transcranial Magnetic Stimulation (rTMS) for treatment-resistant major depressive disorder: An open label trial. Journal Of Affective Disorders, 173, 216-220. doi: 10.1016/j.jad.2014.10.068

O’Reardon, J., Solvason, H., Janicak, P., Sampson, S., Isenberg, K., & Nahas, Z. et al. (2007). Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biological Psychiatry, 62(11), 1208-1216. doi: 10.1016/j.biopsych.2007.01.018

Pandya, M., Altinay, M., Malone, D., & Anand, A. (2012). Where in the Brain Is Depression?. Current Psychiatry Reports, 14(6), 634-642. doi: 10.1007/s11920-012-0322-7

Repetitive Transcranial Magnetic Stimulation as Treatment for Acute Suicidality in Adult Patients – Full Text View – ClinicalTrials.gov. (2018). Retrieved from https://clinicaltrials.gov/ct2/show/NCT02693743

Reyes-López, J., Ricardo-Garcell, J., Armas-Castañeda, G., García-Anaya, M., Arango-De Montis, I., González-Olvera, J., & Pellicer, F. (2017). Clinical improvement in patients with borderline personality disorder after treatment with repetitive Transcranial Magnetic Stimulation: preliminary results. Revista Brasileira De Psiquiatria, 40(1), 97-104. doi: 10.1590/1516-4446-2016-2112

Sheffer, C., Mennemeier, M., Landes, R., Bickel, W., Brackman, S., & Dornhoffer, J. et al. (2013). Neuromodulation of delay discounting, the reflection effect, and cigarette consumption. Journal Of Substance Abuse Treatment, 45(2), 206-214. doi: 10.1016/j.jsat.2013.01.012

Watts, B., Landon, B., Groft, A., & Young-Xu, Y. (2012). A sham controlled study of repetitive Transcranial Magnetic Stimulation for posttraumatic stress disorder. Brain Stimulation, 5(1), 38-43. doi: 10.1016/j.brs.2011.02.002

World Health Organisation. (2014). Preventing suicide: a global imperative. Geneva: World Health Organization. Retrieved from http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/

Zimmerman, M., Mattia, J., & Posternak, M. (2002). Are Subjects in Pharmacological Treatment Trials of Depression Representative of Patients in Routine Clinical Practice?. American Journal Of Psychiatry, 159(3), 469-473. doi: 10.1176/appi.ajp.159.3.46

Ailish, TMS Technician

Ailish TMS technician

Ailish is a member of the the Smart TMS team of technicians at our Dublin TMS Clinic in Ireland.

Her qualifications and experience include:

  • Degree in Psychology through science at Maynooth University.
  • Worked as a volunteer Mental Health carer.
  • Particular interest in Mental Health, Cognition and Neuroscience fields of Psychology.

About TMS Treatment

Transcranial Magnetic Stimulation Therapy at Smart TMS

Repetitive Transcranial Magnetic Stimulation (TMS) is a new approach to treating very difficult mental health conditions and offers hope to millions whose condition is not improved by medication or therapy.

Transcranial Magnetic Stimulation is an innovative treatment which uses magnetic pulses to work directly on the areas of the brain affected by the mental health condition being treated. This could be depression, addiction, PTSD, OCD or anxiety.

Patients have typically spent years on antidepressants and also tried CBT or other talking therapies before finding out about TMS, which offers a completely different approach to treatment.

Contact Us

Smart TMS’s new Transcranial Magnetic Stimulation treatment clinic will be located at:

Pembroke House,
28/32 Pembroke Street Upper,
Dublin 2,
Ireland

For any queries or to book an appointment, please contact us:

Email: info@smarttms.ie

Tel: (01) 254 2514