Journal Article Annotations
2023, 4th Quarter
Annotations by Liliya Gershengoren MD
This is the first randomized clinical study to demonstrate robust antidepressant efficacy for those receiving magnetic seizure therapy (MST) as compared to those undergoing to electroconvulsive therapy (ECT) for up to six months. During the first half of treatment, MST exerted similar antidepressant action and speed of response compared with ECT. However, the mean number of treatments needed to achieve remission was 2.3 less for ECT than MST.
Strength and weaknesses:
A significant strength of this study is that it is the largest double-blind randomized controlled trial (RCT) to date comparing clinical outcomes of MST and ECT. There were technological limitations on MST dosing. Seizure threshold (ST) titration for ECT was performed in steps with relatively high resolution across a wide range of levels, and, once found, doses at 6-times ST could be achieved. Despite using the most powerful MST device available at the time, titration consisted of an initial step of 5 seconds, followed by a single step up to the maximum dose permitted by the device that was subsequently used over the treatment course. For many patients, this dose was likely below 6-times ST.
The study’s findings are relevant for C-L psychiatrists as they highlight the comparative effectiveness and cognitive safety of MST versus ECT in treating major depressive episodes. MST demonstrated similar antidepressant efficacy to the safest form of ECT, with potentially fewer cognitive side effects. This suggests that MST could be a viable alternative to ECT, offering effective treatment for depression while minimizing cognitive risks, which is a crucial consideration in psychiatric practice.