High-frequency repetitive TMS for suicidal ideation in adolescents with depression
Open accessAbstract
Background This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents.Methods Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) "Intensity of Ideation" subscale and Item 13 "Suicidality" on the Children's Depression Rating Scale, Revised (CDRS-R).Results The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity.Limitations This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality.Conclusions The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.
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Other treatments with potentially rapid effects on suicidal thoughts include transcranial magnetic stimulation, magnetic seizure therapy, and chronotherapies.
“Other treatments with potentially rapid effects on suicidal thoughts include transcranial magnetic stimulation (15), magnetic seizure therapy (16), and chronotherapies (17).”
From New methods for assessing rapid changes in suicide risk (2021) · cites this paper as [15]
Ketamine is just one potential rapid intervention; other rapid-acting interventions are likely associated with different patterns of symptom improvement.
“Finally, ketamine is just one potential rapid intervention for depression and suicidal thoughts; other rapid-acting interventions are likely associated with different patterns of symptom improvement (Bryan et al., 2018; Croarkin et al., 2018).”
From Clinical indicators of the suicide crisis and response to ketamine (2025) · cites this paper as Croarkin et al., 2018
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- Authors
- Croarkin, P. E., Nakonezny, P. A., Deng, Z.-D., Romanowicz, M., Voort, J. L. V., Camsari, D. D., Schak, K. M., Port, J. D., & Lewis, C. P.
- Affiliations
- Mayo Clinic (US)
- The University of Texas Southwestern Medical Center (US)
- National Institutes of Health (US)
- Corresponding author
- Croarkin, Paul E.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 239
- Pages
- 282-290
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC6431788
- OpenAlex
- W2883832909
- Cited by
- 95
- References
- 53
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 13 · 2023: 15 · 2022: 15 · 2021: 12 · 2020: 13 · 2019: 6
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH113700)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- high-frequency repetitive transcranial magnetic stimulation, suicidal ideation, adolescent depression, treatment-resistant depression, adjunctive therapy, depression severity, suicide prevention
- MeSH terms
- Adolescent, Depression, Female, Humans, Male, Transcranial Magnetic Stimulation, Suicidal Ideation, Depressive Disorder, Treatment-Resistant
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