Is there a neuroanatomical basis of the vulnerability to suicidal behavior?: a coordinate-based meta-analysis of structural and functional MRI studies

Objective: We conducted meta-analyses of functional and structural neuroimaging studies comparing adolescent and adult individuals with a history of suicidal behavior and a psychiatric disorder to psychiatric controls in order to objectify changes in brain structure and function in association with a vulnerability to suicidal behavior. Methods: Magnetic resonance imaging studies published up to July 2013 investigating structural or functional brain correlates of suicidal behavior were identified through computerized and manual literature searches. Activation foci from 12 studies encompassing 475 individuals, i.e., 213 suicide attempters and 262 psychiatric controls were subjected to meta-analytical study using anatomic or activation likelihood estimation (ALE). Result: Activation likelihood estimation revealed structural deficits and functional changes in association with a history of suicidal behavior. Structural findings included reduced volumes of the rectal gyrus, superior temporal gyrus and caudate nucleus. Functional differences between study groups included an increased reactivity of the anterior and posterior cingulate cortices. Discussion: A history of suicidal behavior appears to be associated with (probably interrelated) structural deficits and functional overactivation in brain areas, which contribute to a decision-making network. The findings suggest that a vulnerability to suicidal behavior can be defined in terms of a reduced motivational control over the intentional behavioral reaction to salient negative stimuli

Accelerated intermittent theta burst stimulation for suicide risk in therapy-resistant depressed patients : a randomized, sham-controlled trial

Objectives: We aimed to examine the effects and safety of accelerated intermittent Theta Burst Stimulation (iTBS) on suicide risk in a group of treatment-resistant unipolar depressed patients, using an extensive suicide assessment scale. Methods: In 50 therapy-resistant, antidepressant-free depressed patients, an intensive protocol of accelerated iTBS was applied over the left dorsolateral prefrontal cortex (DLPFC) in a randomized, sham-controlled crossover design. Patients received 20 iTBS sessions over 4 days. Suicide risk was assessed using the Beck Scale of Suicide ideation (BSI). Results: The iTBS protocol was safe and well tolerated. We observed a significant decrease of the BSI score over time, unrelated to active or sham stimulation and unrelated to depression-response. No worsening of suicidal ideation was observed. The effects of accelerated iTBS on mood and depression severity are reported in Duprat et al. (2016). The decrease in suicide risk lasted up to 1 month after baseline, even in depression non-responders. Conclusions: This accelerated iTBS protocol was safe. The observed significant decrease in suicide risk was unrelated to active or sham stimulation and unrelated to depression response. Further sham-controlled research in suicidal depressed patients is necessary. (Clinicaltrials.gov identifier: NCT01832805)

THE ACUTE EFFECTS OF ACCELERATED REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON SUICIDE RISK IN UNIPOLAR DEPRESSION: PRELIMINARY RESULTS

Background: Suicide is a major health concern. Effective acute interventions are lacking. Recent studies have suggested an acute decrease of suicidal ideations following repetitive Transcranial Magnetic Stimulation (rTMS). However, placebo effects could not be excluded. We aimed to evaluate the acute effect of accelerated intermittent theta burst stimulation (TBS) on suicide risk in depression. Subjects and methods: In 12 suicidal therapy-resistant depressed patients accelerated intermittent TBS was delivered on the left dorsolateral prefrontal cortex in a randomized, sham-controlled cross-over fashion. Patients received 20 sessions spread over 4 days. The change in severity of suicidal ideation was measured by the Beck Scale of Suicidal Ideation (SSI) before and after treatment. Results: We found a significant decrease of SSI score over time; unrelated to active or sham stimulation. Furthermore, the attenuation of suicidal thinking was not merely related to depression severity changes caused by TBS. Conclusions: Accelerated TBS treatment in depressed suicidal patients was found to be safe and well tolerated and may have the potential to acutely decrease suicidal ideations. However, the efficacy compared to sham has not yet been proven and further shamcontrolled research including longer follow-up is needed to substantiate these preliminary findings

Structural and functional neuroimaging studies of the suicidal brain

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The role of neuroimaging in our understanding of the suicidal brain

This paper provides a review of the literature on neuroimaging studies of suicidal behaviour, and discusses the relevance of these studies for our understanding of suicidal behaviour. Main findings from molecular imaging studies include a reduced prefrontal perfusion or metabolism and a blunted increase in activation when challenged in association with a history of suicide attempts. Moreover, impairment of the prefrontal serotonergic system in association with suicidal behaviour is demonstrated in a number of studies. Recent structural and functional imaging studies show changes in cortical and subcortical areas and their connections. A number of methodological issues hamper the interpretation of findings. Nevertheless, when findings from studies using divergent techniques are taken together there is increasing evidence of the involvement of a fronto-cingulo-striatal network in suicidal behaviour. This involvement is supported additionally by findings from neuropsychological studies, which demonstrate changes in decision-making processes in association with suicidal behaviour that rely on the same network. Further study is needed to translate the increasing knowledge from neuroimaging studies in clinical tools for the prediction and prevention of suicidal behaviour

The acute effects of accelerated repetitive transcranial magnetic stimulation on suicide risk in unipolar depression : preliminary results

Background: Suicide is a major health concern. Effective acute interventions are lacking. Recent studies have suggested an acute decrease of suicidal ideations following repetitive Transcranial Magnetic Stimulation (rTMS). However, placebo effects could not be excluded. We aimed to evaluate the acute effect of accelerated intermittent theta burst stimulation (TBS) on suicide risk in depression. Subjects and methods: In 12 suicidal therapy-resistant depressed patients accelerated intermittent TBS was delivered on the left dorsolateral prefrontal cortex in a randomized, sham-controlled cross-over fashion. Patients received 20 sessions spread over 4 days. The change in severity of suicidal ideation was measured by the Beck Scale of Suicidal Ideation (SSI) before and after treatment. Results: We found a significant decrease of SSI score over time; unrelated to active or sham stimulation. Furthermore, the attenuation of suicidal thinking was not merely related to depression severity changes caused by TBS. Conclusions: Accelerated TBS treatment in depressed suicidal patients was found to be safe and well tolerated and may have the potential to acutely decrease suicidal ideations. However, the efficacy compared to sham has not yet been proven and further shamcontrolled research including longer follow-up is needed to substantiate these preliminary findings