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The Catalyst

Treatment found promising for suicidal patients

Staff Report

In the study conducted with veterans at the Ralph H. Johnson VA Medical Center and the Walter Reed National Military Medical Center in Bethesda, M.D., heavy doses of rTMS (repetitive transcranial magnetic stimulation) to the part of the brain controlling emotion effectively cut suicidal thoughts in half after one day. The FDA has already approved the treatment at lower doses to effectively treat depression, and researchers say that the results of this study offer an acute care option for a suicidal patient in crisis.

Transcranial magnetic stimulation therapy pioneer and MUSC Brain Stimulation Laboratory director Mark George, M.D., Department of Psychiatry and Behavioral Sciences, and his colleagues provide a sobering reminder that not only are suicide attempts and csuicides common, there are no proven acute treatments or medications for treating a suicidal crisis. Veterans are even more susceptible to suicide, and with the announcement from  President Barack Obama last week about the final withdrawal of troops scheduled through 2016, more soldiers coming home will be at risk. This study, published in the May/June 2014 issue of Brain Stimulation, may provide an answer to the acute suicidal crisis treatment issue.

“One of our goals was to show that the higher doses were safe and we were able to do that here,” George said.

By aiming the rTMS device at the part of the brain that controls emotions for patients undergoing a suicidal crisis and increasing the magnetic doses, George and his colleagues were able to speed up the process, effectively accelerating the effect for suicidal patients. Instead of 3,000 pulses per day, five days a week, for four weeks for a depressed patient, George and his team increased daily pulses to 18,000 and delivered treatment for only three days. All patients involved in the study received traditional treatment, such as medication and therapy. About half of the 41 study participants also received rTMS, and George said that despite it being blind study, the clinical effect for those receiving treatment was sometimes quite dramatic.

George was quick to point out that this acute treatment is not meant to take the place of medication and therapy but to complement them with an option for someone in an acute crisis where medication and therapy may take days or weeks to be effective. He compares this study to earlier advances in heart care or strokes.

“Early in my career, if someone came into the hospital with heart problems they would be sent home if they weren’t actually having congestive failure,” he said. “The same goes for someone having a stroke. We just didn’t have an effective acute treatment. Now we have protocols even in the ambulance. Public awareness has gone up. People now know when something is wrong with their heart or arms or legs, and they know to go get treatment.”

“Maybe we can do the same thing with suicidal ideation. If we could get people to realize that having thoughts of suicide is a brain problem and get them to come in for treatment, and then help them quickly, can you imagine how many lives we could save? If they don’t come in for treatment, then no amount of medical technology can help. We need to reverse the stigma associated with suicide and developing good acute treatments is one of the best ways of doing that,”George said.

The study was funded by the Department of Defense Congressionally–Directed Medical Research Program through a consortium created to study PTSD and TBI.

June 6, 2014



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