Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review

Abstract

Background

Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and incidence of suicidality remains unclear. Here, we aimed to provide an update on the effects of seizure therapies and noninvasive brain stimulation on suicidality.

Methods

We conducted a systematic review of the literature in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Elsevier ScienceDirect, and Wiley Online Library databases using the MeSH terms “Electroconvulsive Therapy”, “Magnetic Seizure Stimulation”, “repetitive Transcranial Magnetic Stimulation”, “transcranial Direct Current Stimulation”, “Cranial Electrostimulation” and “suicide”. We included studies using seizure therapies and noninvasive brain stimulation as a main intervention that evaluated suicidality, regardless of diagnosis.

Results

Among 1,019 records screened, 26 studies met the inclusion criteria using either electroconvulsive therapy ( n = 14), magnetic seizure therapy ( n = 2), repetitive transcranial magnetic stimulation ( n = 9), or transcranial direct current stimulation ( n = 1). We observed that studies reported significant results, suggesting these techniques can be effective on the suicidal dimension of mental health pathologies, but a general statement regarding their efficacy is premature due to limitations.

Conclusions

Future enquiry is necessary to address methodological limitations and evaluate the long‐term efficacy of these methods both alone and in combination with pharmacotherapy and/or psychotherapy.

Abstract

We provided an update of current evidence on the effects of seizure therapies (electroconvulsive therapy and magnetic seizure therapy) and noninvasive brain stimulations (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcranial electrostimulation) on suicidality. The antisuicidal effect of ECT could be supported, but magnetic seizure therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcranial electrostimulation were not consistently recommended for treating suicidality. Long‐term antisuicidal effect of seizure therapies and noninvasive brain stimulations should be further investigated both alone and in combination with pharmacotherapy or psychotherapy.