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Updated: Jun 19, 2026

Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Does early improvement in major depression protect against treatment emergent suicidal ideation?
Florian Seemüller1, Rebecca Schennach-Wolff, Michael Obermeier
1Department of Psychiatry, Ludwig Maximilians University, Nussbaumstr. 7, Munich, Germany. florian.seemueller@med.uni-muenchen.de
Objective:
To investigate the association of early improvement and treatment emergent suicidal ideation in a large sample (N=705) of naturalistically treated inpatients with major depressive disorder.
Method:
In line with previous reports early improvement was defined as a 20% HAMD improvement within the first two weeks of antidepressant treatment. Treatment emergent suicidal ideation was defined by a sudden increase from 0 or 1 to at least 3 on HAMD item 3 and from 0.1 to at least 4 on MADR item 10 for suicidal ideation. Early improvers were compared with non-early improvers with respect to the occurrence of treatment emergent suicidality during treatment.
Results:
Early improvers were 3 (MADRS) to 3.4 (HAMD) times less likely to experience new emergence of suicidal ideation during the treatment course than non-improvers. In addition, early improvement was associated with significantly less pessimistic thoughts.
Limitations:
The analysis is based on secondary analysis of prospectively collected data. No controlled study design.
Conclusion:
Early improvement is associated with significantly less treatment emergent suicidal ideation for it may provide rapid symptom relief and reduce hopelessness.
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