ECT v. Magnetic Seizure Therapy for Bipolar Depression

 Daniel M. Blumberger, M.D. daniel.blumberger@camh.ca, Fidel Vila Rodriguez, M.D., Shawn M. McClintock, Ph.D., Kevin E. Thorpe, M.Math., Amer M. Burhan, M.B.Ch.B., Karen Foley, M.D., Michelle S. Goodman, Ph.D., … Show All … , and Zafiris J. Daskalakis, M.D. 

https://doi.org/10.1176/appi.ajp.20250955

Abstract

Objective:

Despite the established clinical effectiveness of electroconvulsive therapy (ECT) in the treatment of bipolar depression, its acceptance is limited by concerns over cognitive adverse effects. Magnetic seizure therapy (MST) has shown promise in treating patients with depression, with fewer cognitive adverse effects. The aim of this pilot study was to assess the clinical efficacy and cognitive adverse effects of MST compared to right unilateral ultrabrief-pulse (RUL-UB) ECT in patients with bipolar depression.

Methods:

In this double-blind, randomized, parallel-group pilot clinical trial, participants with bipolar depression received either RUL-UB ECT or MST until they achieved remission, dropped out, or received a maximum of 21 treatments. The primary outcomes were 1) clinical remission as assessed with the 24-item Hamilton Rating Scale for Depression and 2) cognitive adverse effects as assessed with the Autobiographical Memory Test (AMT).

Results:

Of 55 participants who were randomized, 45 received an adequate trial of treatment, of whom 6/20 (30%) in the ECT group and 5/25 (20%) in the MST group achieved remission. Clinically important worsening in autobiographical memory (≥25% decline in AMT score) occurred in 6/27 (22.2%) participants in the ECT group and 2/28 (7.1%) in the MST group. Secondary clinical outcomes were similar in both groups.

Conclusions:

This pilot study demonstrated similar effects on depression symptoms between MST and ECT. MST appeared to have resulted in less worsening of autobiographical memory and was better tolerated, suggesting that it may be a safe clinical application to treat bipolar depression. Given the relatively small sample size of this pilot study, these findings should be considered preliminary.

https://psychiatryonline.org/doi/10.1176/appi.ajp.20250955