TABLE 4.
Summary of rTMS study characteristics
| Study | Study design | Stimulus dose administration | Number of sessions | Frequency of treatment | Analysis | Primary outcome | Results/Authors' conclusions | Evidence (PEDro) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Weissman et al. (2018) | RCT | Blumberger et al., 2011) | Blumberger et al. (2016) | 15 sessions | 5 sessions/w | Baseline, 1st w, 2nd w, 3rd w, 4th w, 5th w, 6th w | 24‐HDRS | Suicidal ideation: Bilateral>Sham | Level 1b | ||
| Left unilateral | Bilateral | Left unilateral | Bilateral | The difference between the left unilateral and sham was not significant. | |||||||
| Age<60y: 100% RMT, 10Hz, 30s intertrain intervals, 1,450 pulses/session | Age<60y: 100% RMT, R: 1Hz; L: 10Hz, 30s intertrain intervals, R: 465, L: 750 pulses/session | 120% AdjRMT, 10Hz, 30s intertrain intervals, 2,100 pulses/session | 120% AdjRMT, R:1Hz; L: 10Hz, 30s intertrain intervals, 2,100 pulses/session | There was a modest correction between change in suicidal ideation and change in depression severity. | |||||||
| Age>60y: 120% RMT, 10Hz, 30s intertrain intervals, 1,450 pulses/session | Age>60y: 120% RMT, R: 1Hz; L: 10Hz, 30s intertrain intervals, R: 465, L: 750 pulses/session | No difference in change in HDRS‐16 score between suicide remitters and nonremitters. | |||||||||
| Wall et al. (2011) | A prospective, open, multicenter study | 120% RMT, 10 Hz, 4‐s train duration, 26‐s intertrain interval, 75 trains, 3,000 pulses/session | 30 sessions | 5 sessions/w | Baseline, 10th session, 20th sessions, 30th sessions, 6th month | CDRS‐R, 17QIDS‐A, CGI‐S, CGI‐I, C‐SSRS, SRQ, AEMF | Expression of suicidal ideation decreased as treatment progressed, commensurate with mood improvement. | Level 2 | |||
| Hadley et al. (2011) | A prospective study | 120% RMT, 10 Hz, 5‐s train duration, 10‐s intertrain intervals, 6,800 pulses/session | 10 sessions | 5 sessions/w | Baseline, after each session | BDI, SSI | Aggressive rTMS might be able to significantly and rapidly reduce suicidal ideation. | Level 2 | |||
| Desmyter et al. (2016) | RCT | 110% RMT, 50 Hz, 54 trains of 10 bursts of 3 stimuli/session, repeated every 200ms, 1,620 pulses/session | 20 sessions | 5 sessions/d | Baseline, 1st w, 2nd w, 1st m, 6th m | SSI, HDRS | A significant decrease in suicide risk was unrelated to active or sham stimulation and unrelated to depression response, lasting up to 1 month. | Level 1a | |||
| George et al. (2014) | RCT | 120% RMT, 10 Hz, 5‐s train duration, 10‐s intertrain intervals for 30 min, 6,000 pulses/session | 9 sessions | 3 sessions/d | Baseline, before, and after each rTMS session | SSI, Subjective visual analog scale | A rapid antisuicidal effect by delivering high doses of left prefrontal rTMS over 3 days wasn't demonstrated. | Level 1a | |||
| Desmyter et al. (2014) | RCT | 100% RMT, 2‐s train duration, 8‐s intertrain interval, 1,620 pulses/session | 20 sessions | 5 sessions/d | Baseline, 1st w, 2nd w | 17‐HDRS, SSI | A significant decrease in SSI score over time was found; unrelated to active or sham stimulation. | Level 1a | |||
| Baeken et al. (2019) | RCT | 110% RMT, 2‐s train duration, 8‐s intertrain interval, 1,620 pulses/session | 20 sessions | 5 sessions/d | Baseline, 1st w, 2nd w, 4th w | BDI, SSI | Both active and sham aiTBS resulted in prompt decreases in suicidal ideation. Placebo responses are related to higher cognitive processes resulting in suicidal ideation attenuation. | Level 1a | |||
| Croarkin et al. (2018) | A prospective study | 120% RMT, 10 Hz, 4‐s train duration, 26‐s intertrain interval, 3,000 pulses/session | 30 sessions | 3–5 sessions/week | Baseline, after 10 sessions, 20 sessions, 30 sessions | CDRS‐R, C‐SSRS, CGI‐S | The predicted odds of suicidal ideation significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. The magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated nonsignificantly in subsequent analyses that adjusted for illness (depression) severity. | Level 2 | |||
| Berlim et al. (2014) | A prospective study | 100% RMT (1er w), gradually increased to 120% during the 2nd w, 20 Hz, 2‐s train duration, 20‐s intertrain interval, 3,000 pulses/session | 20 sessions | 5 sessions/w | Baseline, 5th w | 21‐HDRS, 16‐QIDS‐SR, HAMA, BAI, CGI‐S, SSI | Suicidality ratings were significantly improved by week 5. | Level 2 | |||
Abbreviations: Adj RMT, resting motor threshold adjusted for distance; AEMF, Adverse Event Monitoring Form; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CDRS‐R, Children's Depression Rating Scale‐Revised; CGI‐I, Clinician Global Impressions‐Improvement; CGI‐S, Clinician‐rated global illness severity; C‐SSRS, Columbia Suicide Severity Rating Scale; DTMS, deep transcranial magnetic stimulation; HAMA, Hamilton Anxiety Rating Scale; HDRS, Hamilton depression scale; 17‐HDRS, 17‐item Hamilton depression scale; MADRS, Montgomery–Asberg Depression Rating Scale; RCT, randomized controlled trial; RMT, resting motor threshold; rTMS, repetitive transcranial magnetic stimulation; SRQ, Subjective Reaction Questionnaire; SSI, Beck Scale of Suicidal Ideation; SSI‐CV, Beck Scale for Suicide Ideation‐Chinese Version; 17‐QIDS‐A, 17‐item Quick Inventory of Depressive Symptoms‐Adolescent version; 16‐QIDS‐SR, 16‐item Quick Inventory of Depressive Symptomatology—Self‐Report.