Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression

Abstract

IMPORTANCE There is an unmet need for effective treatments for suicidality in mental disorders. Magnetic seizure therapy (MST) has been investigated as an alternative to electroconvulsive therapy, a known effective treatment for suicidality, in the management of treatment-resistant major depressive disorder, with promising findings. Yet, there are very limited data on the association of MST with suicidality directly. It is important to explore the potential of MST as a viable treatment alternative to electroconvulsive therapy for suicidality. OBJECTIVE To determine the association of MST with suicidality in patients with treatmentresistant major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial took place at a single tertiary care psychiatric facility in Canada. It followed an open-label study design with consecutive treatment cohorts. Consecutive groupings of 67 patients with treatment-resistant major depressive disorder and with baseline suicidality present were treated for up to 24 treatments. The study was run from February 2012 through June 2019. Patients were followed up for 6 months at the end of the treatment period. This post hoc secondary analysis of the trial was performed from January to November 2019. INTERVENTIONS MST was delivered at 100% stimulator output over the prefrontal cortex with low (25 Hz), moderate (50 or 60 Hz), or high (100 Hz) frequency, for a maximum of 24 sessions. MAIN OUTCOMES AND MEASURES Remission from suicidality was measured as an end point score of 0 on the Beck Scale for Suicidal Ideation. A linear mixed model was used to assess the trajectory of Beck Scale for Suicidal Ideation scores. RESULTS A total of 67 patients (mean [SD] age, 46.3 [13.6] years; 40 women [60.0%]) received a mean (SD) of 19.5 (5.1) MST treatments. The overall number of patients achieving remission was 32 (47.8%). Sixteen patients (55.2%) receiving low-frequency MST achieved remission, as well as 12 patients (54.5%) in the moderate-frequency group, and 4 patients (25.0%) in the high-frequency group. The linear mixed model revealed an association of time with Beck Scale for Suicidal Ideation scores (F 8,293.95 = 5.73; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that MST may be an effective treatment for suicidality, and sensitivity analysis shows this may be particularly so at low and moderate frequencies. Future studies should directly compare MST with electroconvulsive therapy for treating suicidality and should evaluate MST as a treatment for suicidality across mental disorders.

Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial

“…If no seizures were generated, an extra stimulation lasting for 20 s was administered immediately. For depression, there is evidence of better seizure quality ( 18 ) and therapeutic effect ( 19 ) when MST is administered with pulse frequencies of 25 and 50 Hz rather than 100 Hz. Moreover, the results of our pilot study showed that 25 Hz pulses may not be optimal in the studied population of Chinese patients with schizophrenia ( 14 ).…”

Confirmatory Efficacy and Safety Trial of Magnetic Seizure Therapy for Depression (CREST-MST): study protocol for a randomized non-inferiority trial of magnetic seizure therapy versus electroconvulsive therapy

“…For both groups, the remission rates with high-frequency MST were significantly greater than the remission rates for low-frequency (25 Hz) MST supporting further investigation of 100 Hz MST. Additionally, an important use of ECT is rapid relief of acute suicidal ideation, and Weissman et al (2020) found remission of suicidal ideation was achieved in 47.8% of patients who endorsed suicidality at baseline in the MST open-label trial[ 62 ]. Findings from the pilot study also suggested that MST is cognitively safe [ 35 ].…”

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

“…The latter include repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and magnetic seizure therapy (MST). All of them have shown to be effective treatment approaches, rTMS ( Brunoni et al, 2017 ; Sonmez et al, 2019 ; De Risio et al, 2020 ), VNS ( Bottomley et al, 2019 ), and tDCS ( Fregni et al, 2021 ) with consistent effects but moderate effect sizes, DBS ( Hitti et al, 2020 ) and MST ( Weissman et al, 2020 ) with promising and positive results in rather small treatment groups, and VNS and DBS being invasive techniques, which require a neurosurgical procedure. Network meta-analytic estimates of non-surgical brain stimulation revealed ECT as the by far most effective treatment for depression with a bitemporal ECT odds ratio of 8.91, high dose right unilateral ECT 7.27, and lower effect sizes of priming rTMS 6.02, MST 5.55, bilateral rTMS 4.92, bilateral theta burst stimulation 4.44, low-frequency right rTMS 3.65, intermittent theta burst stimulation 3.20, high-frequency left rTMS 3.17, and tDCS 2.65 ( Mutz et al, 2019 ).…”