Magnetic Seizure Therapy as Effective as Electroconvulsive Therapy for Treating Depression


Research Highlights

Major depression is one of the most common mental illnesses in the United States, with an estimated 21 million US adults experiencing a depressive episode in 2021. Medication and therapy are often used to treat depression, but it is not works for everyone.

Electroconvulsive therapy (ECT) is a treatment used when people have not found relief from depression symptoms through other treatments. In ECT, an electric current is used to induce widespread seizure activity in the brain. Deprivation leads to chemical changes in the brain that relieve symptoms of depression. Although ECT is effective in reducing symptoms of depression, some people experience memory loss after treatment, especially the loss of memories about their personal history (called autobiographical memories). Sometimes, these memory problems can be severe.

Magnetic seizure therapy (MST) is a newer treatment being studied for depression. It is designed to have all the benefits and fewer of the memory and cognitive effects seen with ECT. In MST, a magnetic coil is held against the scalp. The magnetic coil induces seizures in the brain that are more localized and milder than those created during ECT.

What did the researchers do?

Sarah H. Lisanby, MD, Director of the Noninvasive Neuromodulation Unit in the Experimental Therapeutics and Pathophysiology Branch at the National Institute of Mental Health, and colleagues tested the effectiveness of MST versus ECT for treating depressive symptoms.

The study included 73 participants between the ages of 18 and 90 who had experienced a major depressive episode and were referred for ECT treatment. Participants were randomly assigned to receive ECT (38 participants) or MST (35 participants) three times a week until they achieved remission or until their response to treatment increased.

Model of the electric field induced in the brain with MST and ECT. Credit: This is an open access article distributed under the terms of the CC-BY license. 2023 Deng ZD et al. JAMA Psychiatry.

Clinicians assessed participants for depressive symptoms at the start of the study (before treatment), on the morning of each treatment session, 24 to 72 hours after each treatment session, and twice per month at within 2 months after treatment and once a month thereafter for the duration of the study.

Clinicians also measured the patients’ cognitive abilities at the start of the study and 72 hours after the last treatment session. After each treatment session, participants were asked to rate the presence and severity of possible side effects, such as headache, nausea, dry mouth, muscle pain, confusion, and memory problems.

What are the results of the clinical trial?

Of the participants who completed the full course of treatment (24 for ECT and 29 for MST), 60.4% showed a significant decrease in depressive symptoms, and 43.4% achieved depression remission. When the researchers looked at the effect of MST and ECT treatment on all study participants who completed some treatment along with those who completed the full treatment, they found that 46.6% showed a significant decrease in depressive symptoms and 31.5% achieved complete depression remission.

Mean severity of subjective adverse effects and percentage of participants experiencing them for ECT and MST.  Credit: This is an open access article distributed under the terms of the CC-BY License.  2023 Deng ZD et al.  JAMA Psychiatry.

Mean severity of subjective adverse effects and percentage of participants experiencing them for ECT and MST. Credit: This is an open access article distributed under the terms of the CC-BY License. 2023 Deng ZD et al. JAMA Psychiatry.

The researchers found no significant differences in symptom reduction or remission between the ECT and MST groups, indicating that the treatments were equally effective in relieving depressive symptoms. Participants in the ECT group achieved remission of depression slightly (between 6 and 7 sessions) than the MST group (9 sessions). The antidepressant benefit of both treatments lasted up to 6 months after the last treatment session.

Patients receiving ECT reported more severe headaches, nausea, muscle pain, confusion, and disorientation than participants receiving MST. While global cognitive function remained intact for participants receiving either treatment, patients receiving MST demonstrated greater recall and specificity of autobiographical memories and recovered cognitive orientation after treatment more quickly than those receiving participants receiving ECT.

What do these findings mean?

Clinical trials have found MST to be just as effective in reducing depressive symptoms as ultrabrief right unilateral ECT, the safest form of ECT currently available. MST reduced depressive symptoms for up to 6 months and had fewer side effects than ECT. The improved autobiographical memory performance and faster cognitive orientation seen following MST treatment suggests that it provides a high level of cognitive safety for participants.

The findings show the promise of MST. Larger trials are currently underway to better understand the comparison between MST and ECT and to learn how best to optimize MST delivery and dosing.

Reference

Deng, Z.-D., Luber, B., McClintock, SM, Weiner, RD, Husain, MN, Lisanby, SH (2023). Clinical outcomes of magnetic seizure therapy versus electroconvulsive therapy for major depressive episode: A randomized clinical trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.4599

Grants

MH087739MH002955TR001115

Clinical trial

NCT00488748

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Image Source : www.nimh.nih.gov

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