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Clinical Trial
. 2024 Sep 1:360:108-113.
doi: 10.1016/j.jad.2024.05.109. Epub 2024 May 22.

Trajectories of suicidal ideation during rTMS for treatment-resistant depression

Denghuang Zhan  1 , Elizabeth C Gregory  2 , Afifa Humaira  2 , Hubert Wong  3 , E David Klonsky  4 , Alexander Levit  2 , Lisa Ridgway  2 , Fidel Vila-Rodriguez  5
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Free article
Clinical Trial

Trajectories of suicidal ideation during rTMS for treatment-resistant depression

Denghuang Zhan et al. J Affect Disord. .
Free article

Abstract

Background: rTMS is a safe and effective intervention for treatment-resistant depression (TRD). However, there is limited data on its specific impact on suicidal ideation (SI), and the trajectory of SI over the treatment course.

Objective: This open-label clinical trial investigated SI outcomes and trajectories in patients with TRD receiving low-frequency rTMS (LFR) to the right dorsolateral prefrontal cortex (DLPFC; N = 55).

Methods: A latent class mixed-effect model was used to identify response trajectories for SI as well as core mood symptoms. Logistic regression analyses investigated risk factors associated with identified trajectories.

Results: For each symptom domain, we identified two distinct trajectories during LFR, one tracking improvement (SI: n = 35, 60 %; mood: n = 29, 53 %) and the other tracking no improvement (SI: n = 20, 40 %; mood: n = 26, 47 %). Male sex, higher baseline anxiety, and higher baseline SI were risk factors for no improvement of SI; while higher baseline anxiety and benzodiazepine use were risk factors for no improvement of mood. Mediation analyses showed that anxiety was a risk factor for no improvement of SI and mood independent of benzodiazepine treatment.

Conclusions: This is the first study to investigate trajectories of response to LFR to the right DLPFC. SI and mood improved with LFR in most patients but the severity of anxiety symptoms was a factor of poor prognosis for both. Nuanced characterization of SI response to rTMS may lead to critical insights for individualized targeting strategies.

Keywords: Low frequency rTMS; Right DLPFC; Suicidal ideation; Symptom trajectories; Treatment-resistant depression.

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Conflict of interest statement

Declaration of competing interest The authors declare no financial interests relative to this work. FVR receives research support from CIHR, Brain Canada, Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, and in-kind equipment support for this investigator-initiated trial from MagVenture. He has received honoraria for participation in the advisory board for Janssen.

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