Among various brain stimulation interventions, bitemporal electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) combined with escitalopram can be considered effective at reducing suicidal ideation in patients with depression, according to a
study published today in
The American Journal of Psychiatry.
Why It’s Relevant
The risk of suicidal ideation is elevated in people with depression and other psychiatric illnesses. Studies suggest that the neurobiology of suicidal ideation may be similar across disorders and centered around circuits targeted by brain stimulation devices—which are being tested for a growing number of disorders.
By the Numbers
- Researchers compiled 58 studies that compared active versus sham brain stimulation for a range of disorders and measured suicidal ideation. In addition to ECT and TMS, the studies included other magnetic (e.g., magnetic seizure therapy) and electrical (e.g., vagus nerve stimulation) interventions.
- Among studies that tested brain stimulation by itself, only bitemporal ECT was superior to sham stimulation for suicidal ideation; low-intensity, high-intensity, and ultra-brief bitemporal ECT protocols were all found effective.
- Among a handful of studies that paired brain stimulation with medication, repetitive TMS plus escitalopram was superior to sham stimulation plus antidepressant.
- For both interventions above, superiority was only shown for patients with major depressive disorder.
The Other Side
The studies used several different definitions of suicidal ideation, so quantifying the effectiveness of these interventions was difficult. For example, few studies assessed the remission of suicidality, which is an important clinical outcome, and few included patients with significant suicidality as baseline, which would be an important target group.
Takeaway Message
Overall, this meta-analysis provides evidence that two specific stimulation approaches—one convulsive and one non-convulsive—can be considered for patients with major depression when suicidality may be a primary concern or when medication alone is insufficient or contraindicated.
Related Information
Source
Jenna M. Traynor, et al. The comparative efficacy of noninvasive brain stimulation for suicidal ideation: a network meta-analysis.
The American Journal of Psychiatry. Published April 17, 2026. doi:
10.1176/appi.ajp.20250753
(Image: Getty Images/iStock/Pikovit44)