Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression
Abstract Background Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS)...
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Cambridge University Press
2025-01-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933825100497/type/journal_article |
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| author | Hyewon H. Lee Katharina Göke Rafae A. Wathra Benoit Mulsant Alisson P. Trevizol Jonathan Downar Shawn M. McClintock Sean M. Nestor Yoshihiro Noda Tarek K. Rajji Zafiris J. Daskalakis Daniel M. Blumberger |
| author_facet | Hyewon H. Lee Katharina Göke Rafae A. Wathra Benoit Mulsant Alisson P. Trevizol Jonathan Downar Shawn M. McClintock Sean M. Nestor Yoshihiro Noda Tarek K. Rajji Zafiris J. Daskalakis Daniel M. Blumberger |
| author_sort | Hyewon H. Lee |
| collection | DOAJ |
| description | Abstract
Background
Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).
Methods
Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.
Results
There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].
Conclusions
Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.
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| format | Article |
| id | doaj-art-5d7175df56f549ad93489cbbaf27f3c2 |
| institution | OA Journals |
| issn | 0924-9338 1778-3585 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
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| series | European Psychiatry |
| spelling | doaj-art-5d7175df56f549ad93489cbbaf27f3c22025-08-20T02:35:59ZengCambridge University PressEuropean Psychiatry0924-93381778-35852025-01-016810.1192/j.eurpsy.2025.10049Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depressionHyewon H. Lee0https://orcid.org/0000-0001-5032-0350Katharina Göke1https://orcid.org/0000-0003-4365-0268Rafae A. Wathra2Benoit Mulsant3https://orcid.org/0000-0002-0303-6450Alisson P. Trevizol4Jonathan Downar5Shawn M. McClintock6https://orcid.org/0000-0001-5372-0261Sean M. Nestor7https://orcid.org/0000-0002-8848-5027Yoshihiro Noda8https://orcid.org/0000-0002-2155-0357Tarek K. Rajji9https://orcid.org/0000-0002-8324-2560Zafiris J. Daskalakis10Daniel M. Blumberger11https://orcid.org/0000-0002-8422-5818Temerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaTemerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Institute of Medical Science, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaDepartment of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, Canada Department of Psychiatry, https://ror.org/03dbr7087 Baycrest Health Sciences , Toronto, ON, CanadaTemerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaTemerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaTemerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaDepartment of Psychiatry, https://ror.org/05byvp690 University of Texas Southwestern Medical Center , Dallas, TX, USADepartment of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, Canada Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Center, Toronto, ON, CanadaDepartment of Neuropsychiatry, Faculty of Medicine, https://ror.org/01k8ej563 Keio University School of Medicine , Tokyo, JapanDepartment of Psychiatry, https://ror.org/05byvp690 University of Texas Southwestern Medical Center , Dallas, TX, USADepartment of Psychiatry, https://ror.org/0168r3w48 University of California, San Diego Health , San Diego, CA, USATemerty for Therapeutic Brain Intervention and Campbell Family Research Institute, https://ror.org/03e71c577 Centre for Addiction and Mental Health , Toronto, ON, Canada Department of Psychiatry, Temerty Faculty of Medicine, https://ror.org/03dbr7087 University of Toronto , Toronto, ON, CanadaAbstract Background Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS). Methods Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored. Results There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012]. Conclusions Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI. https://www.cambridge.org/core/product/identifier/S0924933825100497/type/journal_articledepressionlate liferTMSsuicidal ideationtheta burst stimulation |
| spellingShingle | Hyewon H. Lee Katharina Göke Rafae A. Wathra Benoit Mulsant Alisson P. Trevizol Jonathan Downar Shawn M. McClintock Sean M. Nestor Yoshihiro Noda Tarek K. Rajji Zafiris J. Daskalakis Daniel M. Blumberger Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression European Psychiatry depression late life rTMS suicidal ideation theta burst stimulation |
| title | Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression |
| title_full | Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression |
| title_fullStr | Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression |
| title_full_unstemmed | Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression |
| title_short | Clinical effects and correlates of standard rTMS and theta burst stimulation (TBS) on suicidal ideation in late-life depression |
| title_sort | clinical effects and correlates of standard rtms and theta burst stimulation tbs on suicidal ideation in late life depression |
| topic | depression late life rTMS suicidal ideation theta burst stimulation |
| url | https://www.cambridge.org/core/product/identifier/S0924933825100497/type/journal_article |
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