The Comparative Efficacy of Noninvasive Brain Stimulation for Suicidal Ideation: A Network Meta-Analysis

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Trials

Background:

• Noninvasive brain stimulation (NIBS) is a promising approach for reducing suicidal ideation (SI).
• The cross-diagnostic efficacy of various NIBS interventions for SI has not been systematically examined.
• This study addresses the need for a comprehensive review of NIBS for SI across different psychiatric conditions and age groups.

Purpose of the Study:

• To systematically review and conduct a network meta-analysis of noninvasive brain stimulation (NIBS) interventions for reducing suicidal ideation (SI).
• To compare the efficacy of different NIBS techniques across various psychiatric conditions and age spans.
• To identify effective NIBS strategies, alone or in combination with pharmacotherapy, for managing SI.

Main Methods:

• A systematic search of major databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane CENTRAL) was conducted up to March 2023.
• Randomized controlled trials (RCTs) involving NIBS for SI were included, excluding invasive stimulation or studies without SI participants.
• Network meta-analyses were performed to compare the efficacy of NIBS interventions using standardized mean differences (Hedges' g), with analyses stratified by baseline SI and combination with pharmacotherapy.

Main Results:

• Fifty-eight studies were included in meta-analyses. Bitemporal electroconvulsive therapy (ECT) demonstrated superiority over sham stimulation in reducing SI.
• Other nonconvulsive NIBS interventions showed no significant benefit compared to sham stimulation when used without pharmacotherapy.
• Repetitive transcranial magnetic stimulation (TMS) targeting the left dorsolateral prefrontal cortex (DLPFC) in combination with escitalopram significantly reduced SI compared to sham TMS plus a selective serotonin reuptake inhibitor (SSRI).

Conclusions:

• Bitemporal ECT and high-frequency repetitive TMS combined with SSRIs are effective interventions for improving SI.
• Nonconvulsive NIBS, when used without pharmacotherapy, does not show a significant benefit over sham NIBS for reducing SI.
• Findings suggest that combining specific NIBS techniques with pharmacotherapy may enhance treatment efficacy for SI, though limitations such as study heterogeneity and small sample sizes were noted.