New Developments in Electroconvulsive Therapy and Magnetic Seizure Therapy

Abstract

New findings regarding the mechanisms of action of electroconvulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel electrode placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures (eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.

Transcranial magnetic stimulation as a therapeutic tool in psychiatry

“…In a recent randomised, double-blind trial 10 patients had significantly fewer and less severe muscle aches, subjective memory complaints and headaches. MST was in this trial also associated with faster recovery of orientation, and was superior to ECT on measures of attention, retrograde amnesia, and category fluency (Lisanby et al 2001;Burt et al 2002;Lisanby et al 2003;Kosel et al 2003).…”

The ACDC Pilot Trial: Targeting the Anterior Cingulate by Double Cone Coil rTMS for the Treatment of Depression

“…Preclinical studies have demonstrated that rTMS modulates neural circuits and neurotransmitter systems such as dopamine and serotonin [40]. rTMS applied with conventional coils at the DLFPC region modulates cortical b-adrenergic receptors, decreases 5-HT 2 and increases 5-HT 1a serotonergic receptors in the frontal cortex and the ACC [41].…”

The Use of ECT and MST in treating depression

“…Instead, a coil placed on the head is used to generate high frequency, high intensity transcranial magnetic stimulation. Magnetic fi elds pass through the scalp and skull without the impedance affecting electric currents leading to depolarization of neurons in specifi c regions of the superfi cial cortex, which causes focal induction of a generalized seizure (Hoy & Fitzgerald, 2010aLisanby et al, 2003b). The aim is to target specifi c regions and circuits in the brain which are implicated in the pathogenesis of depression, without impinging on deeper, e.g.…”