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Magnetic seizure therapy an option to electroconvulsive therapy in treatment-resistant depression

Magnetic seizure therapy (MST) may be a viable option to electroconvulsive therapy (ECT) in the treatment of depression, found a novel US study in The Journal of Clinical Psychiatry. During six months of continuation MST, two-thirds of participants sustained improvements in depressive symptoms without adverse cognitive effects.

Led by senior author Dr Zafiris Daskalakis, professor of psychiatry and chair of the Department of Psychiatry at the University of San Diego School of Medicine, the study investigated whether continued MST might effectively prevent the relapse of TRD, particularly in comparison with what is known about ECT, the current standard of care but a method with mixed results and a controversial history.

ECT is performed under general anaesthesia, in which small electric currents are passed through the brain, triggering a brief seizure and changes in brain chemistry that reverse symptoms of some mental health conditions, most notably depression and mania.

It dates back to the 1930s, when early treatments involved high doses of electricity administered without anaesthesia, resulting in memory loss, fractured bones and other serious side effects. Contemporary ECT uses much lower levels of electric stimulus in combination with anaesthesia to avoid pain, and muscle relaxants to reduce the physical dangers of a seizure.

ECT often works when other treatments are unsuccessful, but it not always effective for everyone, and some side effects may still occur, such as confusion and memory loss. These concerns, and a lingering public stigma, have limited its widespread use.

MST is a different form of electrical brain stimulation, debuting in the late-1990s. It induces a seizure in the brain by delivering high intensity magnetic field impulses through a magnetic coil. Stimulation can be tightly focused to a region of the brain, with minimal effect on surrounding tissues and fewer cognitive side effects. Like ECT, MST is being studied for treating depression, psychosis and obsessive-compulsive disorder.

While ECT and, to a lesser degree MST, have both been shown in previous research to produce immediate benefit in treating at least some cases of acute or treatment-resistant depression, much less is known about whether continued MST might prevent relapse of mental illness.

In the latest study, the first of its kind, Daskalakis and colleagues investigated whether continued use of MST prevented a recurrence of treatment-resistant (unipolar) major depressive disorder or bipolar depression, which includes symptoms of mania.

The researchers enrolled participants with qualifying diagnoses and who had responded well to an acute course of MST to receive a course of continuation MST.

Between February 2012 and June 2019, 30 participants received 12 continuation MST sessions with decreasing frequency over the course of six months. One-third of them experienced relapse of depression or required psychiatric hospitalisation, with no significant differences between those with unipolar and bipolar depression. However, the other two-thirds sustained improvements in depressive symptoms without any adverse cognitive effects.

The authors noted that the relapse rate for continued MST was lower than earlier research assessing one-time, acute MST: 33% compared with 50%. They also observed that those with suicidal ideation improved with acute MST had sustained resolution of these symptoms throughout the course of continuation MST. Most neurocognitive tests showed no significant differences during MST continuation. Indeed, verbal fluency improved. These results also show that additional MST treatments repeated over a long period of time continued to be a safe and tolerable procedure.

The study size was small, said the authors, but the findings encouraging enough to conduct larger clinical trials, especially in comparing the efficacy of MST to ECT.

Study details
Continuation Magnetic Seizure Therapy for Treatment-Resistant Unipolar or Bipolar Depression

Victor Tang, Daniel Blumberger, Alanah Throop, Shawn McClintock, Daphne Voineskos, Jonathan Downar, Yuliya Knyahnytska, Benoit Mulsant, Paul Fitzgerald, Zafiris Daskalakis,

Published in The Journal of Clinical Psychiatry on 18 October 2021

ABSTRACT
Objective

Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression (TRD) but may be associated with adverse cognitive effects. Magnetic seizure therapy (MST) is a promising alternative convulsive treatment with a safer cognitive profile. Although there is emerging evidence for the efficacy of MST for TRD as an acute treatment, there are no published studies of continuation MST for the prevention of relapse.

Methods
Patients with TRD with a DSM-IV diagnosis of major depressive disorder or bipolar disorder who met response criteria after acute MST were offered continuation MST in a prospective, open-label trial between February 2012 and June 2019. They received 12 continuation MST sessions with decreasing frequency over the course of six months, with additional booster sessions if their depression symptoms started to worsen. The primary outcome was relapse of depression or psychiatric hospitalisation. Secondary outcomes included relapse of suicidal ideation and neurocognitive outcomes.

Results
Thirty participants completing at least one assessment during continuation MST were included in the analysis; 10 (33.3%) relapsed, with no significant differences in survival distributions between unipolar and bipolar groups (χ2 = 0.3, P = .58). Mean (SD) survival time was 18.6 (1.6) weeks. All 17 participants who achieved resolution of baseline suicidality after acute MST remained free of suicidality during the continuation phase. Except for improvement in verbal fluency, neurocognitive test scores did not change during continuation MST.

Conclusions
During six months of continuation MST, two-thirds of participants sustained improvements in depressive symptoms without any adverse cognitive effects. Future studies of continuation MST are warranted, particularly in comparison to ECT.

 

The Journal of Clinical Psychiatry abstract – Continuation Magnetic Seizure Therapy for Treatment-Resistant Unipolar or Bipolar Depression (Open access)

 

See more from MedicalBrief archives:

 

Consider non-surgical brain stimulation for major depression — trials review

 

Brain stimulation reduces suicidal thinking in hard-to-treat depression

 

Deep brain stimulation effective with treatment-resistant depression over long term

 

Lithium reduces re-hospitalisation risk in bipolar patients

 

 

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