Comparison of Efficacy and Safety of Magnetic Seizure Therapy and Electroconvulsive Therapy for Depression: A Systematic Review

Abstract

Objectives: As a new physical therapeutic technique, magnetic seizure therapy (MST) has established efficacy in the treatment of depression with few cognitive side effects, and thus appears to be a potential alternative to electroconvulsive therapy (ECT). The findings of randomized controlled trials (RCTs) examining the efficacy and safety of MST versus ECT for depression are inconsistent. This systematic review of RCTs was designed with the aim of assessing the safety and efficacy of MST versus ECT for patients with depression. Methods: The WanFang, Chinese Journal Net (CNKI), EMBASE, PubMed, Cochrane Library, and PsycINFO databases were systematically searched by three independent investigators, from their inceptions to July 24, 2021. Results: In total, four RCTs (n = 86) were included and analyzed. Meta-analyses of study-defined response (risk ratio (RR) = 1.36; 95% CI = 0.78 to 2.36; p = 0.28; I2 = 0%), study-defined remission (RR = 1.17; 95% CI = 0.61 to 2.23; p = 0.64; I2 = 0%), and the improvement in depressive symptoms (standardized mean difference (SMD) = 0.21; 95% CI = −0.29 to 0.71; p = 0.42; I2 = 0%) did not present significant differences between MST and ECT. Three RCTs evaluated the cognitive effects of MST compared with ECT using different cognitive measuring tools, but with mixed findings. Only two RCTs reported adverse drug reactions (ADRs), but these lacked specific data. Only one RCT reported discontinuation due to any reason. Conclusions: This preliminary study suggests that MST appears to have a similar antidepressant effect as ECT for depression, but mixed findings on adverse cognitive effects were reported.

Clinical Outcomes of Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode

“…In what is, to our knowledge, the largest double-blind RCT to date (N = 73) comparing clinical outcomes of MST and ECT, both groups exhibited similar and robust antidepressant efficacy. This finding aligns with a recent meta-analysis of 4 RCTs (with sample sizes ranging from 6-40), which reported comparable effect sizes between MST and ECT at the end-point assessment and 1-month follow-up . Our study is the first, to our knowledge, to demonstrate durability of antidepressant effects of MST that were comparable with those of ECT for up to 6 months.…”

“…This finding aligns with a recent meta-analysis of 4 RCTs (with sample sizes ranging from 6-40), which reported comparable effect sizes between MST and ECT at the end-point assessment and 1-month follow-up. 20 Our study is the first, to our knowledge, to demonstrate durability of antidepressant effects of MST that were comparable with those of ECT for up to 6 months. It is worth noting that our MST technique diverges from previous RCTs as we used a circular coil (Figure 1) instead of a twin coil.…”

“…An open-label study of MST reported antidepressant benefits and few cognitive adverse effects, consistent with 2 earlier open-label studies . A systematic review of 4 randomized clinical trials (RCTs) that compared ECT and MST, comprising a total of 86 patients with unipolar or bipolar depression, suggested that MST may have similar effect size compared with ECT . However, these studies were limited by small sample sizes and suboptimal dosing.…”

“…14,15 A systematic review of 4 randomized clinical trials (RCTs) that compared ECT and MST, [16][17][18][19] comprising a total of 86 patients with unipolar or bipolar depression, suggested that MST may have similar effect size compared with ECT. 20 However, these studies were limited by small sample sizes and suboptimal dosing. In particular, earlier investigations assessed the efficacy of MST with right unilateral (RUL) ECT administered at 3 times seizure threshold (ST).…”