Rapid and Robust Reduction of Suicidal Ideation and Behavior with Accelerated Theta Burst in Unipolar and Bipolar Depression

BACKGROUND: Suicidal ideation and behavior are major clinical challenges depression, and rapid-acting interventions remain limited. Intermittent theta-burst stimulation (iTBS) has emerged as a promising neuromodulatory technique with potential anti-suicidal and antidepressant effects. OBJECTIVE: To evaluate the efficacy of iTBS in reducing suicidal ideation and behavior in patients with unipolar and bipolar depression. METHODS: Thirty-four patients with depression (17 unipolar, 17 bipolar) completed a 5-day iTBS treatment protocol. Suicidal ideation severity and intensity, suicidal behavior and suicidal risk were assessed at baseline and daily during treatment and after one month using the C-SSRS. Large effect sizes were observed for all outcomes. At the end of treatment, the response and remission rates for suicidal ideation were 97.1% and 73.5%, respectively. No significant differences were observed between unipolar and bipolar patients in overall treatment efficacy, although bipolar patients showed slightly greater improvement in suicidal ideation intensity. At the one-month follow-up, response rates for suicidal ideation were 80% in the unipolar group and 75% in the bipolar group, with remission maintained in 60% and 62.5% of patients, respectively, and an absence of suicidal behavior reported by 100% and 93.8% of each group. CONCLUSION: iTBS is a rapid, effective intervention for reducing suicidality in both unipolar and bipolar depression. The one-month follow-up data indicates that the clinical improvements observed at the end of the five-day treatment course were largely sustained in both groups.