Changing Cognitive Functions and the Thoughts of Suicide by Transcranial Magnetic Stimulation Therapy in Patients with Treatment-Resistant Depression

SOURCE: Psychiatry and Clinical Psychopharmacology. Conference: 11th International Congress on Psychopharmacology and 7th International Symposium on Child and Adolescent Psychopharmacology. Antalya Turkey. 29(Supplement 1) (pp 63-64), 2019


AUTHORS: Ozcan S.; Gica S.; Gulec H.

OBJECTIVE: Suicide is a major public health problem. This destructive symptom has great personal and social costs. It is known that 50-70% of suicide deaths occur in depressed patients. Major depressive disorder (MDD) is a heterogeneous syndrome consisting of many different symptoms. The National Mental Health Institute determined suicidal ideation as the criterion of the research field. About 40% of MDD patients (defined as deficiency to respond to two or more antidepressant trials) were diagnosed with Treatment-Resistant Depression (TRD). In 2008, the FDA approved the Transcranial Magnetic Stimulation (TMS) as a new treatment option for patients with treatment-resistant depression. Thanks to a moderate side effect profile and ease of administration, TMS is a potential alternative to ECT. On the other hand, the number of studies on the effect of TMS treatment for suicide is rather limited compared to ECT. The role of cognitive functions in suicidal ideation in MDD-diagnosed patients has not been adequately examined. In this study, we aimed to examine the relationship between suicidal ideation, cognitive functions and TMS and the relationship between these two parameters.

METHOD(S): This study consists of thirty patients who applied to the outpatient clinics, firstly diagnosed with major depressive disorder (MDD) according to DSM-V and then were referred to TMS treatment due to treatment resistance. The Montgomery-Asberg Depression Rating Scale (MADRS), Colombia Suicide Severity Rating Scale (C-SSRS), Scale for Suicidal Ideation (SSI) and Beck Hopelessness Scale (BHS) were administered before and after the treatment. Computer-based Cambridge Neurophysiological Assessment Battery (CANTAB) was used to assess cognitive flexibility, motor response inhibition, decision-risk taking and social cognition skills.

RESULT(S): There were no statistically significant changes in cognitive tests (IED, SST, CGT) before and after treatment, including cognitive flexibility, motor response inhibition, decision-risk assessment. The test which evaluated social cognition (Emotion Recognition Test) showed statistically significant improvement. Changes in the scores of Beck Hopelessness Scale, Colombian Suicide Severity Rating Scale (CSSRS), Montgomery-Asberg Depression Rating Scale were found to be highly significant. When the relationship between cognitive functions and suicidal ideation was examined, it was determined that Colombia Suicide Severity Rating Scale (C-SSRS) and Suicidal Ideation Scale (SIS) scores were significantly correlated with the Intra-Extra Dimensional Set Shift (IED) test that assessed cognitive flexibility.

CONCLUSION: There was no significant change in cognitive flexibility, decision-making, risk taking and response inhibition functions after rTMS treatment in treatment-resistant depression patients, and it was found that there was a positive change in emotion recognition skills. In the depression clinic, it appeared that there was a significant improvement with treatment of hopelessness thoughts and suicidal thoughts. There was a significant relationship between suicidal ideation and cognitive flexibility as an executive function. We believe that curation of Treatment-Resistant Depression can be more effective through treatments targeting specific symptom clusters such as cognitive functions and suicidal ideation. We recommend increasing the number of studies involving healthy controls and sham groups in this area and working with larger sample groups.