A  look at how repetitive TMS may reduce suicide risk, both by easing depression and by directly calming the brain networks tied to suicidal thinking.

Suicide is one of the most urgent problems in mental health care today. Worldwide, more than 700,000 people die by suicide every year, and for every death there are many more people quietly struggling with thoughts of ending their life. Veterans and first responders, including many of the Canadian Armed Forces and RCMP members we care for at TMS Life Clinic, face a risk that is often higher than the general population. Standard treatments such as antidepressants and talk therapy help many people, but they do not work fast enough or well enough for everyone, especially those with treatment resistant depression or the most severe suicidal thoughts.

This is where repetitive transcranial magnetic stimulation, or TMS, is opening up a promising new path. TMS is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain. It is already well established as a treatment for depression that has not responded to medication. What researchers are now discovering is more exciting still. TMS may reduce suicide risk through two separate but connected routes: by lifting depression, and by directly calming the specific brain circuits that appear to drive suicidal thinking, independent of mood improvement alone.

The Two Ways TMS May Protect Against Suicide

For years, clinicians have noticed that suicidal thoughts often ease alongside depression during a course of TMS treatment. The natural assumption was that TMS simply treats depression, and less depression means less suicidal thinking as a side benefit. That assumption is only part of the story.

A 2020 review and clinic study from the Providence VA Medical Center and Brown University looked closely at this question. The researchers analyzed eleven published studies on TMS and suicidality involving nearly 600 patients, then studied their own group of 43 veterans receiving TMS for depression. They found that while TMS consistently reduced depression symptoms, its effect on suicidal thinking followed its own pattern. In their veteran sample, suicidal ideation dropped significantly after treatment, and this improvement did not always track neatly with how much a person’s depression score changed. In other words, TMS appeared to be doing something for suicide risk beyond simply treating mood.

This finding matters because it suggests TMS is not just an indirect antidepressant effect on suicidal thoughts. It points toward a second, more direct mechanism, one rooted in how TMS reshapes activity in specific brain circuits tied to suicidal thinking itself.

What Is the Suicide Brain Network?

Brain imaging research over the past two decades has shown that suicidal thoughts and behaviors are linked to disruptions across a set of connected brain regions rather than any single area. Regions such as the dorsolateral prefrontal cortex, the ventromedial and ventrolateral prefrontal cortex, the insula, the thalamus, the posterior cingulate cortex, and the anterior cingulate cortex all show unusual patterns of activity and connectivity in people experiencing suicidal thoughts. Many of these regions overlap with two of the brain’s major coordinating systems, the default mode network, which handles self reflection and thinking about the future, and the frontoparietal network, which governs decision making and impulse control.

Scientists have started calling this collection of regions the suicide related damaged network. Rather than treating suicide risk as vague or purely psychological, this research reframes it as something with an identifiable signature in the brain, a signature that may be measurable and, importantly, treatable.

What the Newest Research Found

A study published in Translational Psychiatry in 2025 put this idea to the test in a detailed way. Researchers studied 473 people with major depressive disorder, comparing 369 who reported suicidal symptoms with 104 who did not. Using a technique called normative modeling, which is similar in spirit to a pediatric growth chart but for brain connectivity, they measured how far each person’s brain activity deviated from a healthy reference group of more than 900 people.

The results were striking. People with suicidal symptoms showed significantly larger deviations within the suicide related brain network compared to those without suicidal symptoms. After a course of TMS treatment aimed at the left dorsolateral prefrontal cortex, delivered twice daily over ten days, these deviations moved measurably back toward the healthy range. The effect was strongest among patients who responded well to treatment, whose brain network deviations shifted close to zero after TMS, essentially resembling a healthier pattern of connectivity.

Perhaps most useful for clinical care, the research team found that a person’s baseline brain network deviations could help predict whether they would respond well to TMS, with roughly 75 percent accuracy. This is an early but meaningful step toward being able to identify, before treatment even begins, who is most likely to benefit and to personalize care accordingly.

Together, these findings suggest that TMS does not just treat the symptoms of depression that happen to overlap with suicidal thinking. It appears to physically reshape activity within the very brain circuits that research has linked to suicide risk, offering a plausible biological explanation for why TMS may help even when depression scores alone do not tell the whole story.

Evidence From Veterans in Real World Care

Because veterans and first responders carry a disproportionate share of the burden of suicide risk, real world evidence from veteran populations is especially valuable. The Providence VA study mentioned earlier followed 43 veterans receiving standard TMS care for depression, most of whom had already tried and failed at least one antidepressant medication.

More than half of these veterans reported some level of suicidal thinking before starting TMS. After completing treatment, suicidal ideation had dropped significantly, and remission rates, meaning suicidal thoughts had disappeared entirely, reached as high as 58 to 62 percent depending on the measurement tool used. When the researchers looked specifically at veterans who had suicidal thoughts at the start of treatment, they found a large and statistically robust reduction in ideation, and this reduction held up even after accounting for how much a person’s depression symptoms had improved. This is exactly the kind of independent, direct effect on suicidal thinking that the brain imaging research helps explain.

What This Means for You

For both civilian patients and for the veterans and RCMP members we are proud to serve at TMS Life Clinic, the growing evidence base tells a consistent and hopeful story. TMS appears to work on suicide risk through two complementary channels. It reduces the burden of treatment resistant depression, which is itself one of the strongest known contributors to suicide risk. And it appears to directly influence the specific brain circuits, spanning the prefrontal cortex, insula, thalamus, and connected networks, that research increasingly links to suicidal thinking itself.

This dual mechanism helps explain why some patients notice their sense of hopelessness and suicidal thoughts easing even before their broader mood fully lifts, and it strengthens the case for TMS as a meaningful option for people who have not found relief through medication or therapy alone. As research continues, including work exploring how brain based markers might one day help personalize treatment even further, TMS stands out as one of the more promising tools available for addressing both depression and suicide risk at their roots.

If you or someone you know is struggling with treatment resistant depression or suicidal thoughts, please know that support is available. Our team at TMS Life Clinic works closely with veterans, RCMP members, and civilians alike to build individualized care plans, and no physician referral is required to begin an assessment.

References

Wang, S., Chen, C., Wang, J., Hao, R., Liu, Y., Mao, F., & Zhang, B. (2025). Modulation of suicide-related neural circuits by transcranial magnetic stimulation and its role in reducing suicide risk. Translational Psychiatry. https://doi.org/10.1038/s41398-025-03790-w

Bozzay, M. L., Primack, J., Barredo, J., & Philip, N. S. (2020). Transcranial magnetic stimulation to reduce suicidality, a review and naturalistic outcomes. Journal of Psychiatric Research, 125, 106-112. https://doi.org/10.1016/j.jpsychires.2020.03.016