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Neurophysiological biomarkers of treatment response in suicidal ideation: a systematic review
Noah Stapper1,2, Lindsay L Benster1,2, Sahit Menon2
1SDSU UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
Background:
Suicidal ideation (SI) is associated with increased morbidity and is one of the main modifiable risk factors for suicide. While initial evidence indicates the efficacy of several treatments for SI, most treatments were not developed to specifically target SI and are often associated with side effects or high relapse rates. Limited understanding of the neurophysiological basis of SI has hindered the optimization of these treatments.
Methods:
This systematic review synthesizes the evidence on neurophysiological biomarkers associated with treatment-induced changes in SI in the context of clinical trials. A systematic literature of the Embase, PubMed, and PsycInfo databases was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
Results:
Twenty-four articles were eligible for inclusion in this review, with most published within the past five years. The studies showed methodological heterogeneity, leading to limited convergence in findings. Many studies were limited by non-randomized study design, concurrent interventions, incomplete treatment protocols, and unvalidated assessments of SI. Despite these limitations, the findings suggest the involvement of the anterior cingulate cortex (ACC) in the anti-suicidal effects of intravenous (IV) ketamine. Notably, this effect was absent in patients treated with oral ketamine, possibly explaining the clinically superior anti-suicidal effects of IV-ketamine compared to the oral administration. Improvements in SI following electroconvulsive therapy and magnetic seizure therapy were associated with activity in the prefrontal cortex (PFC).
Conclusion:
These findings may indicate that the differential modulation of the ACC and PFC is linked to the acute, yet transient effects of IV-ketamine and the sustained effects of seizure therapies. Future studies designed to prospectively assess the efficacy of SI treatments should include these potential biomarkers of treatment response in their design.
Insights
Neuroimaging reveals brain regions like the ACC and PFC are linked to treatment effectiveness for suicidal ideation (SI). Understanding these biomarkers may improve therapies targeting SI.
Area of Science:
- Neuroscience
- Psychiatry
- Biomarkers
Background:
- Suicidal ideation (SI) is a major public health concern linked to significant morbidity and mortality.
- Current treatments for SI often lack specificity, have side effects, or high relapse rates.
- A deeper understanding of the neurophysiological underpinnings of SI is crucial for treatment optimization.
Purpose of the Study:
- To systematically review neurophysiological biomarkers associated with treatment-induced changes in suicidal ideation (SI).
- To synthesize evidence from clinical trials on brain activity changes related to SI treatment efficacy.
Main Methods:
- A systematic literature search of Embase, PubMed, and PsycInfo databases was performed.
- The review followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
- Included studies focused on neurophysiological changes in patients undergoing treatment for SI.
Main Results:
- Twenty-four articles were included, with a recent publication trend.
- Methodological heterogeneity was noted, limiting conclusive findings.
- Evidence suggests anterior cingulate cortex (ACC) involvement in intravenous (IV) ketamine's anti-suicidal effects, contrasting with oral ketamine.
- Prefrontal cortex (PFC) activity changes correlated with improvements in SI following electroconvulsive therapy and magnetic seizure therapy.
Conclusions:
- Differential modulation of the ACC and PFC may underlie the distinct effects of ketamine and seizure therapies on SI.
- These brain regions represent potential biomarkers for treatment response in SI.
- Future research should prospectively incorporate these biomarkers to evaluate SI treatment efficacy.
