Suicide protocol TMS

Treating suicidal ideation with TMS

Dr. Mark George and Marie Steen did a study in some VA medical centers, showing that if you stimulate in the left DLPFC at ten hertz, five seconds on, ten seconds off and you keep doing that for thirty minutes, then you pause and you do it again and then you pause and you do it again – so three times at thirty minutes – the first day, second day and third day then there’s a reduction in suicidal ideation. We have found that the same protocol works very well and by the end of the second day, none of our patients have had any suicidal ideation, which is very encouraging.

Unfortunately, the three-day protocol doesn’t seem to have a lasting effect for depression. The idea that suicide and depression might work differently is an idea that probably will be explored in the future because some people get very very depressed and never get suicidal and some people do get suicidal. When you reduce the suicidality, the depression doesn’t necessarily follow and that’s what I’ve seen with the suicide protocol. It’s very very good for reduction of suicide, for reducing risk, but it doesn’t take the place of a full course of TMS for depression.

On the other hand, there are several other, what are called accelerated protocols, involving multiple treatments per day for depression. The hope is that within the next two to five years, we’ll have protocols that are three to five days and you’re done, or two to three days a week and you’re done, so the people can do it on the weekend instead of weekdays. In the future, accelerated protocols will be an area of great interest.