Evidence map›Paper›PMID 41323432›Full record

ReviewNeuroscience applied2025

Electroconvulsive therapy reduces suicidality and all-cause mortality in refractory depression: A systematic review and meta-analysis of neurostimulation studies.

Jolein Odermatt, Jan Sarlon, Neysan Schaefer, Sarah Ulrich, Magdalena Ridder, Else Schneider, Undine E Lang, Timur Liwinski, Annette B Brühl

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Neuroscience applied, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jolein OdermattUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Jan SarlonUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Neysan SchaeferUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Sarah UlrichUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Magdalena RidderUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Else SchneiderUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Undine E LangUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Timur LiwinskiUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.
Annette B BrühlUniversity Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Depressive disorders are among the most common psychiatric disorders worldwide and associated with half of all suicides. There is robust evidence indicating that both electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) effectively alleviate depressive symptoms in difficult-to-treat depression and enhance patient outcomes. However, there remains ongoing debate regarding their potential roles in preventing suicide and reducing all-cause mortality. Our study aims to investigate the impact of various neurostimulation techniques, including ECT, rTMS, and vagus nerve stimulation (VNS), on reducing suicidality, including suicidal ideation and completed suicides, as well as on overall mortality among individuals diagnosed with depression. In this systematic review and meta-analysis, we searched on MEDLINE via PubMed until January 9, 2024 for randomised controlled trials and controlled observational studies that investigated suicide and all-cause mortality outcomes after neurostimulation treatment for depression. Of the 1351 screened records we identified 26 studies eligible for inclusion in our systematic review. We included 11 studies on ECT (involving 17'890 subjects treated with ECT and 25'367 controls receiving treatment as usual), 5 studies on rTMS and 3 studies on VNS in our meta-analysis. In the cumulative cohort, 208 suicide deaths (1.70 %) were observed in the ECT group and 988 suicide deaths (5.02 %) were registered in the control group. Moreover, there were 511 deaths from all causes (3.13 %) in the ECT group, compared to 1325 deaths (6.64 %) in the control group. Thus, treatment with ECT demonstrated a significant 34 % decrease in the odds of suicide (OR 0.66, 95 % CI 0.50-0.88, p = 0.0047) and a 30 % reduction of death from all causes (OR 0.70, 95 % CI 0.62-0.79, p < 0.0001). The standardized mean difference (SMD) for suicidal ideation before and after ECT was -0.58 (95 % CI -0.10 to -1.07, p = 0.0177), suggesting a moderate effect size. We found no significant effect of rTMS on suicidal ideation with an SMD of -0.41 (95 % CI -1.01 - 0.19, p = 0.1795). In patients treated with VNS a 60 % reduction in the odds of death from all causes was observed (OR 0.40, 95 % CI 0.18-0.92, p = 0.0306). To conclude, there is consistent observational data supporting the protective effects of ECT against suicide and overall mortality. The systematic review protocol is registered online on PROSPERO, CRD42023412887.

Indexed as

Bipolar disorderDepressionElectroconvulsive therapyMajor depressive disorderMortalityRepetitive transcranial magnetic stimulationSuicidalitySuicide

Identifiers

PMID41323432
PMCPMC12664644

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.