Suicidality is a major public health problem. It is a term that encompasses the spectrum of suicidal behaviors and thoughts. At least 800 000 people worldwide are known to die by suicide each year. About 90% of the people who die by suicide have a primary psychiatric illness.
Despite this, there is an unmet requirement for effective suicidality treatment in mental disorders. Electroconvulsive therapy is known to be an effective treatment for suicidality and MST has been investigated as its alternative for the management of the treatment-resistant major depressive disorder, with promising findings. Yet. there is a dearth of data on the association of MST with suicidality directly. It is important to explore the potential of MST as a viable alternative to electroconvulsive therapy for suicidality. Keeping this in mind, Cory R. Weissman, University of Toronto, Toronto, Ontario, Canada, and colleagues determined the association of MST with suicidality in patients with treatment-resistant major depressive disorder.
The trial was conducted at single tertiary care in Canada. The researchers followed a design of open-label study ith consecutive treatment cohorts. Consecutive groupings of 67 patients with treatment-resistant major depressive disorder and with baseline suicidality present were treated for up to 24 treatments. The study was run from February 2012 through June 2019. Patients were followed up for 6 months at the end of the treatment period.
MST was delivered at 100% stimulator output over the prefrontal cortex with low (25 Hz), moderate (50 or 60 Hz), or high (100 Hz) frequency, for a maximum of 24 sessions.
Remission from suicidality was measured as an endpoint score of 0 on the Beck Scale for Suicidal Ideation.
Key findings of the study include:
- The overall number of patients achieving remission was 32 (47.8%).
- Sixteen patients (55.2%) receiving low-frequency MST achieved remission, as well as 12 patients (54.5%) in the moderate-frequency group, and 4 patients (25.0%) in the high-frequency group.
- The linear mixed model revealed an association of time with Beck Scale for Suicidal Ideation scores (F8,293.95 = 5.73).
"These findings suggest that MST may be an effective treatment for suicidality, and sensitivity analysis shows this may be particularly so at low and moderate frequencies," wrote the authors.
"Future studies should directly compare MST with electroconvulsive therapy for treating suicidality and should evaluate MST as a treatment for suicidality across mental disorders," they concluded.
The study, "Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression," is published in JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2020.7434
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