Introduction Magnetic seizure therapy (MST), in which seizures are elicited with a high-frequency magnetic field, is under development as a new treatment for major depressive disorder. Its use may be justified if it produces the antidepressant effects of ECT, coupled with limited cognitive side effects. This pilot study reports shortened recovery times after MST compared with ECT as a preliminary step to evaluate the usefulness of a new 100Hz MST device. Methods We induced seizures with 100Hz magnetic transcranial stimulation in eleven patients with major depressive disorder during one session of a regular course of ECT. Recovery times after these MST and ECT induced seizures were compared. Results Seizures could be elicited in ten of the eleven patients. Stimulation over the vertex produced tonic-clonic activity on nine out of eleven occasions. Stimulation over the prefrontal midpoint elicited seizures on three out of seven occasions. The mean duration of magnetically induced seizures was 31.3 sec, ranging from 10-86 sec. All patients had an exceptionally quick recovery of orientation: mean of 7 min 12 sec (SD = 2 min 7 sec, range 4 min 20 sec – 9 min 41 sec). The recovery times were on average 15 min 35 sec shorter with MST than with ECT in the same patients (paired-samples t-test: p = 0.00009). Patients reported feeling less confused after MST. Side effects were confined to myoclonic movements, associated with the use of etomidate. Conclusions The new 100 Hz magnetic stimulator elicits seizures in the majority of patients when administered over the vertex. MST was associated with shorter recovery times and less confusion following treatment. Subsequent work will be required to assess the safety and effectiveness of MST in the treatment of depression.

BackgroundDepression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient’s general prognosis. But screening for these potential comorbidities in a hospital’s accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia.MethodsThis cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity.ResultsWe found the Arabic version of the HADS to be acceptable for 95 % of the subjects. We used Cronbach’s alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales.ConclusionThe HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.

The ECT is still highly effective in severely treatment-resistant patients with major depressive disorder, with more than half of such patients achieving remission.

Etomidate has a distinct advantage over thiopental in producing seizures of adequate duration during ECT and should be used as the first-line measure in augmenting seizures in patients who have very high seizure thresholds.

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