ECT and Reduction of Suicidality: New Systematic Review

Out on PubMed from researchers in China and France is this review:

Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review.

Chen Y, Magnin C, Brunelin J, Leaune E, Fang Y, Poulet E.Brain Behav. 2021 Apr 10:e02144. doi: 10.1002/brb3.2144. Online ahead of print.PMID: 33838000 

The abstract is copied below:
Background: Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and incidence of suicidality remains unclear. Here, we aimed to provide an update on the effects of seizure therapies and noninvasive brain stimulation on suicidality.

Methods: We conducted a systematic review of the literature in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Elsevier ScienceDirect, and Wiley Online Library databases using the MeSH terms "Electroconvulsive Therapy", "Magnetic Seizure Stimulation", "repetitive Transcranial Magnetic Stimulation", "transcranial Direct Current Stimulation", "Cranial Electrostimulation" and "suicide". We included studies using seizure therapies and noninvasive brain stimulation as a main intervention that evaluated suicidality, regardless of diagnosis.

Results: Among 1,019 records screened, 26 studies met the inclusion criteria using either electroconvulsive therapy (n = 14), magnetic seizure therapy (n = 2), repetitive transcranial magnetic stimulation (n = 9), or transcranial direct current stimulation (n = 1). We observed that studies reported significant results, suggesting these techniques can be effective on the suicidal dimension of mental health pathologies, but a general statement regarding their efficacy is premature due to limitations.

Conclusions: Future enquiry is necessary to address methodological limitations and evaluate the long-term efficacy of these methods both alone and in combination with pharmacotherapy and/or psychotherapy.

Keywords: cranial electrostimulation; electroconvulsive therapy; repetitive transcranial magnetic stimulation; suicide; transcranial direct current stimulation.

The pdf is here.



and from the text:


This systematic review is on a very important topic and needed to be done. Despite decades of experience that ECT quickly reduces suicidal drive in melancholic depression, the long term effect on suicide has been difficult to prove in research studies. The reasons for this are complex, but include confounding by indication (patients who get ECT have the most severe and recurrent forms of the illnesses associated with suicidal behavior) and various difficulties of long-term cohort studies. The results compiled here are largely positive for ECT, but still somewhat less impressive than the clinical reality.
I approached this review with enthusiasm,and was initially glad to see the CORE study from 2005 among the analysed papers. However, when I read the details, so much was incorrect (study design, electrode placement) that I hardly recognized the study and it made me wonder about the quality of the rest of the report...
Nonetheless, this is such an important topic that I recommend a full read of this paper, at least the ECT sections,~20 minutes.

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