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.
Bibliographical noteFunding Information:
Conflict of Interest: CL receives grant support from the Brain & Behavior Research Foundation as the Alan G. Ross Memorial Investigator. He has been a site investigator for multicenter trials funded by Neuronetics, Inc. and NeoSync, Inc. PC has received research grant support from the National Institute of Mental Health, Brain & Behavior Research Foundation, Neuronetics, Inc., and Pfizer, Inc. He has received equipment support from Neuronetics Inc. and MagVenture, Inc. He has received supplies and genotyping services from Assurex Health, Inc. for investigator-initiated studies. He was the primary investigator for a multicenter study funded by Neuronetics, Inc. and a site primary investigator for a study funded by NeoSync, Inc. He has served as a paid consultant for Engrail Therapeutics, Myriad Neuroscience, Procter & Gamble Company, and Sunovion.
This work was supported by grants from the Brain & Behavior Research Foundation (CL, 2018 NARSAD Young Investigator Grant 27488, Alan G. Ross Memorial Investigator) and the National Institute of Mental Health (PC, R01 MH113700 and R01 MH124655).
© Copyright © 2021 Kucuker, Almorsy, Sonmez, Ligezka, Doruk Camsari, Lewis and Croarkin.
- deep brain stimulation
- electroconvulsive therapy
- repetitive transcranial magnetic simulation
- transcranial direct current stimulation
- vagal nerve stimulation
PubMed: MeSH publication types
- Systematic Review