Non-invasive brain stimulation for suicidal ideation: a systematic review and metanalysis of the current literature

Fiammetta Iannuzzo; Fabrizio Turiaco; Vincenzo Messina; Alessandro Magazzù Minutoli; Maria Catena Silvestri; Maria Rosaria Anna Muscatello; Antonio Bruno; Fiammetta Iannuzzo; Fabrizio Turiaco; Vincenzo Messina; Alessandro Magazzù Minutoli; Maria Catena Silvestri; Maria Rosaria Anna Muscatello; Antonio Bruno

doi:10.3934/Neuroscience.2025018

AIMS Neuroscience

2025, Volume 12, Issue 3: 332-350. doi: 10.3934/Neuroscience.2025018

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Review

Non-invasive brain stimulation for suicidal ideation: a systematic review and metanalysis of the current literature

Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy

Received: 12 June 2025 Revised: 08 July 2025 Accepted: 16 July 2025 Published: 25 July 2025

Data suggests that the available therapeutic tools are still insufficient to deal with suicidality. Non-Invasive Brain Stimulation techniques (NIBS) have entered the recognized guidelines for therapies in psychiatry due to the advantages related to safety and tolerability. The purpose of this review and meta-analysis is to assess if and how NIBS techniques are used and could be effective in the treatment of suicidal ideation. The search included the Scopus, Pubmed, and Web of Science databases. The word “suicide” was combined with “NIBS”, “transcranial magnetic stimulation” (TMS), “deep TMS” and “transcranial direct current stimulation”. Nine studies met the inclusion criteria and were included in the review. High frequency repetitive TMS (rTMS) protocols were associated with a significant reduction in suicidal ideation, with individual studies reporting improvements ranging from 20% to over 35% on scales such as the scale for suicide ideation (SSI) and the Beck scale of suicide ideation (BSI) (p < 0.01; p < 0.01; p < 0.001). The meta-analysis showed that active rTMS significantly reduced suicidal ideation compared to sham control conditions (Z = 16.79, p < 0.0001). Heterogeneity was high (I² = 99%, chi-square = 473.22, df = 3, p < 0.0001). High frequency rTMS protocols appeared most effective; deep TMS (dTMS) showed mixed results, and only one study utilized transcranial direct current stimulation (tDCS). Due to limited data, no meta-analysis was conducted on dTMS or tDCS studies. Although preliminary findings suggest a potential for NIBS techniques to reduce suicidal ideation, the current evidence is limited by the small number of high-quality studies and heterogeneity in the protocols and outcomes. Therefore, conclusions regarding clinical efficacy should be considered tentative.
- suicide,
- suicide ideation,
- NIBS,
- TMS,
- Deep TMS,
- tDCS
Citation: Fiammetta Iannuzzo, Fabrizio Turiaco, Vincenzo Messina, Alessandro Magazzù Minutoli, Maria Catena Silvestri, Maria Rosaria Anna Muscatello, Antonio Bruno. Non-invasive brain stimulation for suicidal ideation: a systematic review and metanalysis of the current literature[J]. AIMS Neuroscience, 2025, 12(3): 332-350. doi: 10.3934/Neuroscience.2025018

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Abstract

Data suggests that the available therapeutic tools are still insufficient to deal with suicidality. Non-Invasive Brain Stimulation techniques (NIBS) have entered the recognized guidelines for therapies in psychiatry due to the advantages related to safety and tolerability. The purpose of this review and meta-analysis is to assess if and how NIBS techniques are used and could be effective in the treatment of suicidal ideation. The search included the Scopus, Pubmed, and Web of Science databases. The word “suicide” was combined with “NIBS”, “transcranial magnetic stimulation” (TMS), “deep TMS” and “transcranial direct current stimulation”. Nine studies met the inclusion criteria and were included in the review. High frequency repetitive TMS (rTMS) protocols were associated with a significant reduction in suicidal ideation, with individual studies reporting improvements ranging from 20% to over 35% on scales such as the scale for suicide ideation (SSI) and the Beck scale of suicide ideation (BSI) (p < 0.01; p < 0.01; p < 0.001). The meta-analysis showed that active rTMS significantly reduced suicidal ideation compared to sham control conditions (Z = 16.79, p < 0.0001). Heterogeneity was high (I² = 99%, chi-square = 473.22, df = 3, p < 0.0001). High frequency rTMS protocols appeared most effective; deep TMS (dTMS) showed mixed results, and only one study utilized transcranial direct current stimulation (tDCS). Due to limited data, no meta-analysis was conducted on dTMS or tDCS studies. Although preliminary findings suggest a potential for NIBS techniques to reduce suicidal ideation, the current evidence is limited by the small number of high-quality studies and heterogeneity in the protocols and outcomes. Therefore, conclusions regarding clinical efficacy should be considered tentative.

Conflict of interest

Antonio Bruno is an editorial board member for AIMS Neuroscience and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

Authors' contributions

Fiammetta Iannuzzo: conceptualization, investigation, data curation, formal analysis, and writing – original draft; Fabrizio Turiaco: investigation, data curation, formal analysis; Vincenzo Messina: investigation, data curation, formal analysis; Alessandro Magazzù Minutoli: validation, data curation, formal analysis; Maria Catena Silvestri: validation, data curation, formal analysis; Maria Rosaria Anna Muscatello: supervision, and writing – review & editing; Antonio Bruno: conceptualisation, methodology, supervision, writing – original draft, and writing – review & editing. All authors reviewed the results and approved the final version of the manuscript.

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