Although there is growing interest in the use of repetitive Transcranial Magnetic Stimulation (TMS) as a treatment for suicidality, efficacy data in this area, and knowledge of potential treatment mechanisms, remains limited. The first objective of this study was to systematically review clinical trial data examining the effectiveness of TMS as a treatment for suicidal ideation. Our secondary objective was to investigate the extent to which changes in suicidality are independent of improvements in depression in a clinical sample of veterans who received TMS treatment. In Study 1, we searched the Pubmed and biRxiv databases from inception until July 2019 to identify studies that examined the efficacy of TMS for suicidal thoughts and/or behaviors. Data regarding sample characteristics, treatment parameters, and results were synthesized from six randomized controlled trials and five unblinded trials (total n = 593). Our systematic review indicated that while TMS was consistently associated with reduced depression, its impact on suicidality is unclear. Interpretation of results related to suicidality were complicated by study design elements and modest sample sizes. In Study 2, we conducted a retrospective analysis of 43 patients who received care for depression in a neuromodulation clinic at a Veteran's Affairs hospital. Results found significant decreases in suicidal ideation, and depressive symptom change did not always account for improvements in ideation. Taken together, our literature review and clinic study indicate preliminary promise of TMS for suicide, and underscore the need for more fine-grained, suicide-specific TMS research.

中文翻译：

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经颅磁刺激减少自杀倾向-综述和自然结果。

尽管人们越来越关注使用重复经颅磁刺激（TMS）来治疗自杀性，但该领域的疗效数据以及潜在治疗机制的知识仍然有限。这项研究的第一个目的是系统地审查临床试验数据，以检查TMS作为自杀意念治疗的有效性。我们的次要目标是调查接受TMS治疗的退伍军人临床样本中自杀性变化的程度与抑郁症的改善无关。在研究1中，我们从成立到2019年7月一直在Pubmed和biRxiv数据库中进行搜索，以鉴定研究TMS对自杀念头和/或行为的功效的研究。有关样品特性，处理参数，并从六项随机对照试验和五项非盲试验（总n = 593）中得出结果。我们的系统评价表明，尽管TMS始终与抑郁症的缓解相关，但其对自杀的影响尚不清楚。研究设计元素和适中的样本量使与自杀有关的结果解释变得复杂。在研究2中，我们对在退伍军人事务医院的神经调节诊所接受抑郁症治疗的43例患者进行了回顾性分析。结果发现自杀意念明显减少，而抑郁症状的改变并不总是说明意念有所改善。综上所述，我们的文献综述和临床研究表明TMS具有自杀的初步前景，并强调了对更细粒度，针对自杀的TMS研究的需求。