rTMS (Repetitive transcranial magnetic stimulation) as a brain stimulation modality is approved to treat treatment-resistant depression. Its efficacy in depression and anxiety is well supported in several studies. However, its direct effect on suicidality is still unclear, unlike electroconvulsive therapy. This study aims to evaluate the effectiveness of rTMS on pessimistic and suicidal thoughts. We hypothesized that rTMS reduces pessimistic and suicidal thoughts, alongside other symptoms, in patients experiencing depression and anxiety as the therapy progresses over six weeks.

The study is a retrospective observational study. The study was conducted in the rTMS Clinic, Brentwood. All of the patients undergoing treatment at the rTMS Clinic were assessed with subjective and objective scales for depression. One of the scales was MADRS (Montgomery Asperger's Depression Rating Scale); this was used to study the response of therapy. I looked into the pessimistic and suicidal thoughts component in MADRS, the baseline score was recorded, and its progression on weekly monitoring for six weeks was noted.

63 patients attended the rTMS clinic from January 2019 to October 2022. 21 patients were excluded for reasons that included dropping out before completion of treatment, MADRS weekly scores not being available, and some of them still undergoing treatment. A total of 42 patients, 21 male and 21 female, who successfully finished rTMS therapy at the Neuromodulation clinic were included in the study.

The study showed that rTMS was effective and well-tolerated in reducing pessimistic and suicidal thoughts in the majority of patients. Average baseline scores and their average weekly progressions for pessimistic and suicidal thoughts over six week's period were recorded. The average score of baseline pessimistic thoughts was 3.925, and baseline suicidal thoughts was 3, in the severity scale of 0–6. There was a gradual reduction in scores of pessimistic and suicidal thoughts from baseline to the end of intensive six-week treatment. Scores measured at the end of every week showed a reduction in scores from the previous week of treatment. Average scores at the end of six weeks showed 2.375 and 1.65 in the pessimistic and suicidal thought domains respectively in the MADRS scale.

rTMS is being used for symptoms of depression and anxiety and evidence is encouraging in treating symptoms including pessimistic and suicidal thoughts. rTMS therapy over six weeks showed a gradual reduction in the severity of pessimistic and suicidal thoughts, demonstrated by decreases in average MADRS weekly score.