Magnetic seizure therapy is as effective as electroconvulsive therapy for treating depression.


Research highlights

Major depression is one of the most common mental disorders in the United States, with an estimated 21 million American adults expected to experience a depressive episode in 2021. Medication and therapy are often used to treat depression, but they don’t work for everyone.

Electroconvulsive therapy (ECT) is a treatment that is used when people do not get relief from depression symptoms through other treatments. In ECT, electrical current is used to induce widespread seizure activity in the brain. Seizures cause 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, particularly loss of memories about their personal history (called autobiographical memories). Sometimes, these memory problems can be serious.

Magnetic seizure therapy (MST) is a new treatment being studied for depression. It is designed to have all the benefits seen with ECT and fewer memory and cognitive side effects. In MST, a magnetic coil is placed against the skull. 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. Lisonby, MD, director of the Noninvasive Neuromodulation Unit in the Branch of Experimental Clinical and Pathophysiology at the National Institute of Mental Health, and her colleagues tested the effectiveness of MST compared to ECT for treating symptoms of depression.

The study involved 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 ended.

Model of induced electric fields 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.

Model of induced electric fields 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 depressive symptoms at the beginning of the study (before treatment), on the morning of each treatment session, 24 to 72 hours after each treatment session, and twice per month for 2 months after treatment ended, and once a month thereafter. Evaluated participants for. Duration of study.

Therapists also measured the patients’ cognitive abilities at the beginning 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, such as headache, nausea, dry mouth, muscle pain, confusion, and memory problems.

What were the results of the clinical trials?

Of the 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 remission from depression. When researchers looked at the effects of MST and ECT treatments on all study participants who completed some of the treatment, compared with those who completed all of the treatment, they found that 46.6% experienced a significant reduction in depression symptoms. observed and 31.5% achieved complete depression relief.

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

Average severity of subjective adverse effects for ECT and MST and percentage of participants experiencing them. 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 depression symptoms. Participants in the ECT group achieved relief from depression slightly sooner (between 6 and 7 sessions) than those in the MST group (9 sessions). The antidepressant benefits of both treatments lasted for 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 any treatment, patients receiving MST showed greater recall and specificity of autobiographical memories and achieved cognitive orientation faster after treatment than participants receiving ECT.

What Do These Findings Mean?

Clinical trials found that MST is as effective as ultrabrief right unilateral ECT in reducing depression symptoms, which is the safest form of ECT currently available. MST reduced depression 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 suggests that it provided a high level of cognitive protection for the 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 best optimize the delivery and dosage of MST.

Reference

Deng, Z.-D., Luber, B., McClintock, S.M., Weiner, R.D., Hussain, M.N., Lisonby, S.H. (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

Grant

MH087739MH002955TR001115

clinical trials

NCT00488748

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Image Source : www.nimh.nih.gov

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