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Magnetic seizure therapy versus electroconvulsive therapy: clinical and cognitive outcomes in depression

Magnetic seizure therapy versus electroconvulsive therapy: clinical and cognitive outcomes in depression

Magnetic seizure therapy was found to be non-inferior to electroconvulsive therapy in achieving remission in depression and was associated with substantially fewer adverse effects on autobiographical memory.

The study aimed to compare electroconvulsive therapy (ECT), one of the most effective treatments for a major depressive episode (MDE) in unipolar and bipolar depression, with magnetic seizure therapy (MST), a newer form of convulsive therapy that appears to have a more favorable cognitive side-effect profile. Two randomized, double-blind, parallel-group clinical trials (ClinicalTrials.gov NCT03191058 and NCT03641300) compared frontal MST with right unilateral ultrabrief-pulse ECT (RUL-UB ECT); participants older than 18 years with an MDE diagnosis received treatment until remission, withdrawal from the study, or a maximum of 21 sessions. The primary efficacy outcome was remission of depression, and the primary cognitive outcome was autobiographical memory. A total of 291 participants were randomized across five centers; the difference in remission rates was 6.0 percentage points in favor of RUL-UB ECT (28.1% versus 22.1% with MST), and MST was shown to be non-inferior using a non-inferiority margin of 15 percentage points (p=0.047; upper bound of the 95% confidence interval, 14.8 percentage points). The rate of significant deterioration in autobiographical memory was 19.1% among participants receiving RUL-UB ECT, compared with 3.7% among those receiving MST (p<0.001); non-inferiority was established for all secondary outcomes, including suicidal ideation, and there were few serious adverse events. In conclusion, MST was reported to be non-inferior to ECT in achieving remission of depressive symptoms and superior in terms of its cognitive side-effect profile, with the overall benefit–harm balance supporting consideration of MST as a first-line convulsive therapy for depression.

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