Intermittent theta-burst stimulation with adjunctive D-cycloserine rapidly resolves suicidal ideation and decreases implicit association with death/suicide

• DOI: 10.1017/s0033291724003313
• Publication Date: 2025-02-05T06:43:28Z
• Authors: Myren N. Sohn; Jaeden Cole; Signe L. Bray; Alexander McGirr

Abstract Background Depressive disorders are the most common diagnosis among individuals who die by suicide, and intermittent theta-burst stimulation (iTBS) is a noninvasive treatment for those with difficult-to-treat depression at higher risk suicide. Previous data suggests that pairing iTBS D-cycloserine, partial N-methyl-D-aspartate (NMDA) receptor agonist, improves antidepressant outcomes. However, its impact on suicide not known. Methods We examine suicidal ideation implicit after iTBS+D-cycloserine in two clinical trials (open-label trial [ n = 12] randomized placebo-controlled [RCT, 50]) involving adults major depressive disorder acute effects of D-cycloserine crossover ( 18). Implicit was assessed using computerized death/suicide association test (IAT), symptoms were clinician-rated Montgomery–Asberg Depression Rating Scale (MADRS). Results Open-label associated rapid reduction ideation, superior to iTBS+placebo reducing ideation. Similarly, open-label decreased as measured IAT, greater decreases IAT scores compared iTBS+placebo. A single dose absence had no effect risk. Conclusions Adjunctive promising strategy reduce depression.