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Cited by 25Electroconvulsive Therapy StudiesTranscranial Magnetic Stimulation StudiesSuicide and Self-Harm Studies

A Systematic Review of Neuromodulation Treatment Effects on Suicidality

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Kucuker, Mehmet Utku, Almorsy, Ammar G., Sonmez, Ayse Irem, Ligezka, Anna N., Doruk Camsari, Deniz, Lewis, Charles P., Croarkin, Paul E.·2021·Frontiers in Human Neuroscience
DOI 10.3389/fnhum.2021.660926PMC PMC8267816
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Abstract

Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality. Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality. Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality. Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599 , identifier: CRD42019125599.

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Authors
Kucuker, M. U., Almorsy, A. G., Sonmez, A. I., Ligezka, A. N., Doruk Camsari, D., Lewis, C. P., & Croarkin, P. E.
Affiliations
  • Mayo Clinic (US)
  • University of Minnesota (US)
Corresponding author
Croarkin, Paul E.
ORCID
Venue
Frontiers in Human Neuroscience
Publisher
Frontiers Media SA
Published
2021-06-25
Volume
15
Pages
660926-660926
ISSN
1662-5161 (ISSN-L)
DOI
10.3389/fnhum.2021.660926
PMC
PMC8267816
OpenAlex
W3173630243
Cited by
25
References
184
Citations by year
2026: 5 · 2025: 8 · 2024: 5 · 2023: 4 · 2022: 3
FWCI
0.54
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Human Neuroscience (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute of Mental Health (R01 MH113700)
  • National Alliance for Research on Schizophrenia and Depression
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
neuromodulation, suicidality, suicidal ideation, suicide attempts, suicide mortality, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, electroconvulsive therapy, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulation, sertraline, depression

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