Major depression is one of the most common mental health disorders in the United States, with an estimated 21 million U.S. adults experiencing an episode in 2021. Medication and therapy are often used to treat depression, but they don’t work for everyone.
Electroconvulsive therapy (ECT) is one treatment used when people have not found relief from depression symptoms with other treatments. In ECT, an electrical current is used to induce widespread seizure activity in the brain. A seizure 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 memories of their personal history (called autobiographical memories). Sometimes these memory problems can be serious.
Magnetic seizure therapy (MST) is a newer form of treatment being studied for depression. It is designed to provide all the benefits of ECT with fewer memory and cognitive side effects. In MST, the magnetic coil is held against the scalp. The magnetic coil causes 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 of the National Institute of Mental Health’s Division of Experimental Therapeutics and Pathophysiology, and colleagues tested the effectiveness of MST compared with ECT in the treatment of depressive symptoms.
The study involved 73 participants between the ages of 18 and 90 who had experienced a major depressive episode and had been 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 response to treatment plateaued.
Clinicians assessed participants for depressive symptoms at the beginning of the study (before treatment), on the morning of each treatment session, 24–72 hours after each treatment session, and twice monthly for 2 months after the end of treatment and once monthly thereafter. the duration of the study.
The doctors also measured the cognitive abilities of the patients at the beginning of the study and 72 hours after the last treatment session. After each treatment, participants were asked to rate the occurrence and severity of potential side effects, such as headache, nausea, dry mouth, muscle pain, confusion, and memory problems.
What were the results of the clinical trial?
Of the participants who completed the entire treatment period (24 for ECT and 29 for MST), 60.4% experienced a significant reduction 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 percent experienced a significant reduction in depressive symptoms and 31.5 percent 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 relieving depression symptoms. Participants in the ECT group achieved depression remission slightly earlier (6-7 sessions) than in the MST group (9 sessions). The antidepressant benefit of both treatments lasted up to 6 months after the last treatment.
Patients who received ECT reported more severe headache, nausea, muscle pain, confusion, and disorientation than patients who received MST. Although global cognitive functions remained unchanged in participants who received either treatment, patients who received MST demonstrated better recall and specificity of their autobiographical memories and returned to cognitive orientation faster after treatment than participants who received ECT.
What do these findings mean?
A clinical trial found MST to be 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. Improved autobiographical memory and faster cognitive orienting observed after MST treatment suggest that it provides participants with a high level of cognitive safety.
The results show the promise of MST. Larger trials are currently underway to better understand the comparison between MST and ECT and to learn how to optimize the delivery and dosing of MST.
Deng, Z.-D., Luber, B., McClintock, SM, Weiner, RD, Husain, MN, Lisanby, SH (2023). Clinical outcomes of magnetic seizure therapy versus electroconvulsive therapy in major depressive episode: a randomized clinical trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.4599
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