Suicide is a major public health problem that can occur due to several mental, demographic, social, and cultural factors. According to the World Health Organization (WHO), approximately 800000 people die due to suicide each year. Suicide does not just occur in high-income countries, but is a global phenomenon and occurs throughout the lifespan, and is the second leading cause of death among 15-29-years-old globally .
It has been estimated by WHO, that around 1.53 million people will die from suicide worldwide in 2020. This represents on average one death every 20 seconds and one attempt every 1–2 seconds .
According to the most recent available data originating from the Iranian Legal Medicine Organization (ILMO), nationwide rates of suicide were 5.7 per 100,000 for males and 3.1 for females .
Suicidal thoughts and acts are not merely behaviors, but can also be symptoms of a depressive episode and a diagnostic criterion in the diagnosis of Borderline Personality Disorder (BPD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Notably, suicidal behavior and ideation has been implicated as a comorbidity of several neuropsychiatric disorders including BPD, schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD), and is one of the leading causes of preventable death among people with these disorders .
It should be noted that many of the attempters (45.3%) reported at least one psychiatric disorder during their lifetime . Major depressive disorder (22.0%), panic disorder (6.3%), and obsessive-compulsive disorder (6.0%) were the most common psychiatric diagnoses.
In the current study, we aim to propose a novel treatment approach to reduce the probability of re-committing suicide in different etiologies of that.
The most common emergency treatment for people who come with recognizes of suicidal attempts and ideation is Electroconvulsive Therapy (ECT) [6–8].
Although medication therapy is the most recommended treating method in subjects with suicidal attempts and ideation, ECT represents adequate evidence for treatment according to published data[7, 9, 10].
There are some disadvantages related to the application of ECT in the treatment process. The
most problematic issues are the acceptability of ECT related to repeated general anesthesia, application of an electric charge through the brain, induction of a seizure, and cognitive impairment side effects .
Headache, disorientation, and memory complaints are the most common subjective side-effects. Both subjective complaints [12, 13] and objective measures of cognitive impairment can worsen during treatment.
Although, there has been evidence demonstrating the ECT as a first-line treatment for people who have suicidal attempts and ideation , according to the mentioned problems still adverse cognitive side-effects of ECT need to be considered.
To diminish these challenges, a new method entitled repetitive Transcranial Magnetic Stimulation (rTMS) could be recommended as an alternative neuromodulation approach for subjects who have suicidal ideation and attempt, recently .
In particular, it has been suggested to carry out rTMS in those patients who are unable to have treatment with ECT. This method has been approved by the FDA in 2008 [16, 17, 18].
The application of rTMS in the area of psychiatry has several advantages such as it is nonconvulsive, requires no anesthesia, hasn't a notably side effects profile, and may even improve cognitive performance . Due to its highly positive impacts, it is being increasingly investigated as a potential treatment approach for distinct neuropsychiatric disorders , and several recent meta-analyses have confirmed its overall efficacy and safety for treating MDD [21–23].
This method has been used to treat some neurodegenerative disorders in recent years such as Parkinson’s disease (PD) and Alzheimer (AD) [24–26]. In addition to the mentioned disorders, researchers try to treat Migraine [27, 28]; Obsessive–compulsive disorder (OCD) [29, 30], and Anxiety [31, 32] with this kind of new neuromodulation methods during the past two decades.
Due to its minimal side effects and relatively less burden on patients, their families, and the mental health system, rTMS has been considered a potentially attractive therapeutic intervention in the method for psychiatric disorders [33, 34].
This new method as an alternative to ECT can be suggested as a first-line treatment and management tool in a critical situation for individuals who have suicidal attempts and ideation.
In the current study, we aim to report an open-labeled study of using rTMS with a combination of LORETA in adult males who had recently attempted suicide with prominent ideation.