Grant: Project Grant

Suicide is the most severe outcome in mental illness and remains of the greatest public health challenges. Unfortunately, despite years of successful prevention initiatives suicide rates have plateaued in Canada. New ways of treating and preventing suicide are urgently needed. One strategy is to target specific circuits in the brain using non-invasive neurostimulation interventions such as transcranial magnetic stimulation (TMS). TMS is well established in the treatment of Major Depression, and has been shown to reduce suicidal ideation. Yet, this treatment typically involves daily interventions over weeks to have effect, and benefit from treatment is not guaranteed. Those at risk of suicide cannot afford to wait weeks for an uncertain benefit. Our compelling pilot data suggests that by pairing stimulation with a small molecule, DCycloserine, suicide risk resolves rapidly. Indeed, suicidal ideation quickly decreases in severity and performance on computerized tests of implicit suicide risk improve. This is important, because these tests use implicit association to capture whether the person aligns themselves more strongly with life or with death/suicide and performance on the test is associated with future suicidal behavior. It is possible, therefore, that this intervention could not only treat acute suicide risk but also change trajectories of suicidal behavior. We propose to conduct a clinical trial in individuals who are at the highest risk for suicide, namely individuals who have previously survived a suicide attempt and who are currently suicidal. Individuals will be randomized to receive an accelerated form of TMS in which treatments are delivered twice daily paired with either a placebo or D-Cycloserine to determine the effect on suicidal ideation, implicit suicide risk, and suicidal ideation in the 6 months following treatment. The results of this study may provide a new means of decreasing suicide risk.