Accelerated left dorsolateral prefrontal cortex transcranial magnetic stimulation for suicidality in patients with depressive disorders: A case series

Background: Suicidality in depression presents significant management challenges, with limited treatment options such as electroconvulsive therapy (ECT) and ketamine. Repetitive transcranial magnetic stimulation (rTMS) is an emerging intervention for such cases, particularly when ECT is contraindicated. This chart review examines the clinical outcomes of accelerated TMS (aTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) for suicidality in depression patients. Cases: Six patients with depression and suicidality underwent aTMS targeting the left DLPFC between June 2024 to March 2025. Excitatory rTMS was administered using intermittent theta burst stimulation (iTBS) at 100%–120% of RMT. Treatment sessions were delivered over 6.17 ± 1.86 days, with a 60-min intersession interval to maximize cortical excitability. Symptom severity was assessed using the Columbia Suicide Severity Rating Scale (CSSRS) as the primary outcome measure and Hamilton Depression Rating Scale (HDRS). Significant reductions were observed in CSSRS scores (mean difference 11.87, 95% CI: 5.63, 18.0), corresponding to a 73.3% reduction in suicide severity. HDRS also improved significantly (mean difference 18.2, 95% CI: 13.50, 22.8), corresponding to a 73.1% reduction. All but one patient achieved a treatment response, and four patients met remission criteria. The interventions were well-tolerated, with no serious adverse effects. Conclusion: This study provides preliminary evidence supporting the efficacy, safety, and rapid reduction in suicidality with left DLPFC aTMS in depression. Randomized controlled trials are needed to validate these results, optimize treatment protocols, and assess the durability of clinical benefits.