• Research Highlights
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. The crisis leads to chemical changes in the brain that relieve the symptoms of depression. Although ECT is effective in reducing symptoms of depression, some people experience memory loss after treatment, especially 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 side effects—seen with ECT. In MST, a magnetic coil is held on the scalp. The magnetic coil produces seizures in the brain that are much more localized and milder than those produced during ECT.
What did the researchers do?
Sarah H. Lisanby, MD, Director of the Noninvasive Neuromodulation Unit in the Division of Experimental Therapeutics and Pathophysiology at the National Institute of Mental Health, and colleagues examined the effectiveness of MST compared with ECT for the treatment of 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 per week until they achieved remission or until their treatment response normalized.
Clinicians assessed participants for depressive symptoms at baseline (before treatment), on the morning of each treatment session, 24 to 72 hours after each treatment session, and twice monthly for 2 months after the end of treatment, and once once a month thereafter for the duration of the study.
Clinicians also measured 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 potential side effects, including headache, nausea, dry mouth, muscle pain, confusion, and memory problems.
What were the results of the clinical trial?
Among participants who completed the full course of treatment (24 for ECT and 29 for MST), 60.4% experienced a significant reduction in depressive symptoms and 43.4% achieved depression remission. When researchers looked at the impact of MST and ECT treatment on all study participants—those who completed some treatment in combination with those who completed full treatment—they found that 46.6 percent experienced a significant reduction in depressive symptoms and 31.5% achieved complete depression remission.
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 alleviating depressive symptoms. Participants in the ECT group achieved depression remission slightly earlier (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 who received ECT reported more severe headaches, nausea, muscle pain, confusion, and disorientation than participants who received MST. While global cognition remained intact for participants who received either treatment, patients who received MST showed greater recall and specificity of autobiographical memories and regained cognitive orientation after treatment more quickly than participants who received ECT.
What do these findings mean?
The clinical trial found MST to be just as effective in reducing depressive symptoms as ultra-brief 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 observed after MST treatment suggest that it provides a high level of cognitive security to participants.
The findings demonstrate the promise of MST. Larger trials are currently underway to better understand the comparison between MST and ECT and to learn how to better optimize the delivery and dosing of MST.
Report
Deng, Z.-D., Luber, B., McClintock, SM, Weiner, RD, Husain, MN, Lisanby, SH (2023). Clinical outcomes of magnetic resonance therapy versus electroconvulsive therapy for major depressive episode: A randomized clinical trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.4599
Grants
MH087739 , MH002955 , TR001115
