Accelerated intermittent theta burst stimulation effectively and rapidly reduces suicidal ideation in depression patients: A randomized, sham-controlled study

Background: Suicidal ideation is common among patients with treatment-resistant depression (TRD), underscoring the need for rapid and safe therapeutic options. Objective: This study examined whether accelerated intermittent theta burst stimulation (iTBS) can rapidly reduce suicidal ideation in TRD inpatients while maintaining pharmacological stability and cognitive safety. Methods: In a randomized, double-blind, placebo-controlled trial, 100 TRD inpatients with suicidal ideation received either active or sham accelerated iTBS over two weeks. The primary outcome was change in Beck Scale for Suicide Ideation (BSS) scores; secondary outcomes included depressive symptoms and cognitive performance. Results: Active accelerated iTBS produced significantly greater reductions in suicidal ideation than sham beginning at week 2 (mean ± SD: 10.0 ± 7.4 vs. 13.2 ± 8.8, p = 0.036), with effects sustained through week 6. Response rates on the BSS were also higher in the active group at week 2 (50% vs. 18%, p < 0.001). Antidepressant effects emerged as early as week 1. Importantly, these clinical improvements occurred without changes in concomitant medications and without any adverse effects on cognitive function, supporting the specificity and safety of the intervention. Conclusions: Accelerated iTBS is a rapid-acting, safe, and cognitively neutral treatment for reducing suicidal ideation and depressive symptoms in TRD inpatients, highlighting its potential utility in acute psychiatric care.