A Pilot Safety and Feasibility Study of High Dose Left Prefrontal Transcranial Magnetic Stimulation (TMS) to Rapidly Stabilize Suicidal Patients with PTSD or TBI, or Both
Background and Rationale: The world in general and the military in particular need a quick, safe, and effective acute treatment for suicidal thinking or ideation (SI). There are good acute medically-based treatments for stroke, heart attacks, and even seizures. However, with SI, there is not a fast-acting effective intervention and thus many patients do not seek treatment when they should. For those who do seek treatment and are admitted to a hospital, medications usually take several weeks to work, and not all patients are good candidates for talking therapy – called cognitive behavioral therapy (CBT). Electroconvulsive therapy (ECT) is overly invasive, requiring general anesthesia, and has cognitive side effects.
There has been a recent breakthrough with a new treatment called daily left prefrontal transcranial magnetic stimulation (TMS). This non-invasive method was recently (2008) FDA approved for treating acute depression. There are now over 100 machines in psychiatrist’s offices in the US, and a unit at Walter Reed Hospital in Washington. TMS is proving to be a good, non-invasive, non-medication alternative treatment for depression.
Recent studies suggest that higher doses of TMS than were used in the large studies can quickly reduce suicidal thinking, within several days. If this is true, this treatment could transform how we deal with suicidal patients, and save lives. TMS is safe and largely side-effect free. With prior government funding, our group even created a small, portable TMS device able to be used in outpatient clinics and even triage areas or field hospitals. There is intense interest in using this in the VA or DOD, but many unanswered questions remain before it could be widely adopted for treating SI.
This grant is designed to refine how we might use TMS to treat suicidal ideation. It is a clinical trial at two sites – the Ralph H. Johnson VA Medical Center (RHJVAMC) in Charleston, SC, and Walter Reed Army Hospital in Washington DC.
Objective/Hypothesis: We will enroll 60 suicidal adults admitted over 2 years to either Walter Reed or RHJVAMC. We will give patients TMS or sham TMS for three days on top of their normal treatment. We want to find out whether TMS is feasible in this setting, and whether it reduces suicidal thinking immediately. Even more important, we will follow these patients and look at how long they stay in the hospital, and how their suicidal thinking does for the next 6 months.