Multimodal Elements of Suicidality Reduction After Transcranial Magnetic Stimulation

Area of Science:

• Neuroscience
• Psychiatry
• Medical Imaging

Background:

• Repetitive transcranial magnetic stimulation (TMS) shows promise for treating suicidality.
• Neural mechanisms underlying TMS efficacy for suicidality are not well understood.
• Previous research linked frontostriatal functional connectivity to suicidality severity.

Purpose of the Study:

• To investigate if reduced frontostriatal functional connectivity correlates with decreased suicidality after TMS.
• To explore the relationship between changes in frontostriatal connectivity and white matter (WM) organization.

Main Methods:

• Functional connectivity analysis using seed-based methods on 25 participants with comorbid PTSD and depression receiving 5 Hz TMS.
• Clinical symptoms, including suicidality, were assessed using the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and PTSD Checklist for DSM-5 (PCL-5).
• Diffusion connectometry analyzed WM integrity in a subsample (N=17) to correlate with functional connectivity changes.

Main Results:

• Suicidal ideation decreased in 65% of participants.
• A significant correlation was found between reduced suicidality and decreased functional connectivity between the dorsal striatum and frontopolar cortex (p < 0.001).
• Frontostriatal WM integrity may influence the functional connectivity response to TMS for suicidality.

Conclusions:

• Targeted reduction of frontostriatal connectivity via TMS may be an effective treatment for suicidality.
• This multimodal approach can inform individualized TMS strategies for high-risk patients.
• Further research is needed to advance personalized neuromodulation techniques.