Electroconvulsive therapy (ECT) is effective for major depressive disorder (MDD) but its effects on memory limit its widespread use. Magnetic seizure therapy (MST) is a potential alternative to ECT that may not adversely affect memory. In the current trial, consecutive patients with MDD consented to receive MST applied over the prefrontal cortex according to an open-label protocol. Depressive symptoms and cognition were assessed prior to, during and at the end of treatment. Patients were treated two to three times per week with high-frequency MST (i.e., 100 Hz) (N = 24), medium frequency MST (i.e., 60 or 50 Hz) (N = 26), or low-frequency MST (i.e., 25 Hz MST) (N = 36) using 100% stimulator output. One hundred and forty patients were screened; 86 patients with MDD received a minimum of eight treatments and were deemed to have an adequate course of MST; and 47 completed the trial per protocol, either achieving remission (i.e., 24-item Hamilton Rating Scale for Depression score <10 and a relative reduction of >60% at two consecutive assessments; n = 17) or received a maximum of 24 sessions (n = 30). High-frequency (100 Hz) MST produced the highest remission rate (33.3%). Performance on most cognitive measures remained stable, with the exception of significantly worsened recall consistency of autobiographical information and significantly improved brief visuospatial memory task performance. Under open conditions, MST led to clinically meaningful reduction in depressive symptoms in patients with MDD and produced minimal cognitive impairment. Future studies should compare MST and ECT under double-blind randomized condition.
Subscribe to Journal
Get full journal access for 1 year
only $43.69 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Patten SB, Kennedy SH, Lam RW, O’Donovan C, Filteau MJ, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management. J Affect Disord. 2009;117(Suppl 1):S5–14.
Lepine JP, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7:3–7.
Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905–1917.
Group UER. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003;361:799–808.
Wilkinson ST, Agbese E, Leslie DL, Rosenheck RA. Identifying recipients of electroconvulsive therapy: data from privately insured Americans. Psychiatr Serv. 2018.
Deng ZD, Lisanby SH, Peterchev AV. Electric field strength and focality in electroconvulsive therapy and magnetic seizure therapy: a finite element simulation study. J Neural Eng. 2011;8:016007.
McClintock SM, Tirmizi O, Chansard M, Husain MM. A systematic review of the neurocognitive effects of magnetic seizure therapy. Int Rev Psychiatry. 2011;23:413–423.
Kosel M, Frick C, Lisanby SH, Fisch HU, Schlaepfer TE. Magnetic seizure therapy improves mood in refractory major depression. Neuropsychopharmacology. 2003;28:2045–2048.
Lisanby SH, Schlaepfer TE, Fisch HU, Sackeim HA. Magnetic seizure therapy of major depression. Arch Gen Psychiatry. 2001;58:303–305.
Kayser S, Bewernick BH, Matusch A, Hurlemann R, Soehle M, Schlaepfer TE. Magnetic seizure therapy in treatment-resistant depression: clinical, neuropsychological and metabolic effects. Psychol Med. 2015;45:1073–1092.
Fitzgerald PB, Hoy KE, Herring SE, Clinton AM, Downey G, Daskalakis ZJ. Pilot study of the clinical and cognitive effects of high-frequency magnetic seizure therapy in major depressive disorder. Depress Anxiety. 2013;30:129–136.
Fitzgerald PB, Hoy KE, Elliot D, McQueen S, Wambeek LE, Chen L, et al. A pilot study of the comparative efficacy of 100 Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression. Depress Anxiety. 2018;35:393–401.
Peterchev AV, Rosa MA, Deng ZD, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010;26:159–174.
Grimm S, Beck J, Schuepbach D, Hell D, Boesiger P, Bermpohl F, et al. Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biol Psychiatry. 2008;63:369–376.
Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41:237–248.
Oquendo MA, Baca-Garcia E, Kartachov A, Khait V, Campbell CE, Richards M, et al. A computer algorithm for calculating the adequacy of antidepressant treatment in unipolar and bipolar depression. J Clin Psychiatry. 2003;64:825–833.
Oquendo MA, Malone KM, Ellis SP, Sackeim HA, Mann JJ. Inadequacy of antidepressant treatment for patients with major depression who are at risk for suicidal behavior. Am J Psychiatry. 1999;156:190–194.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–699.
Wechsler D. Wechsler test of adult reading. San Antonio, TX: WTAR; 2001.
Patterson J. Controlled oral word association test. In: Kreutzer JS, DeLuca J. editors. Encyclopedia of clinical neuropsychology. New York, NY: Springer; 2001.
Nuechterlein KH, Green MF, Kern RS, Baade LE, Barch DM, Cohen JD, et al. The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. Am J Psychiatry. 2008;165:203–213.
Trenerry MR, Crosson B, DeBoe J, Leber WR. Stroop neuropsychological screening test. Odessa, FL: Psychological Assessment Resources; 1989.
McElhiney MC, Moody BJ, Sackeim HA. The autobiographical memory interview—short form. In: Psychiatry DoB, editor. New York: New York State Psychiatric Institute; 2001.
Kayser S, Bewernick BH, Grubert C, Hadrysiewicz BL, Axmacher N, Schlaepfer TE. Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. J Psychiatr Res. 2011;45:569–576.
Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008;1:71–83.
Backhouse FA, Noda Y, Knyahnytska Y, Farzan F, Downar J, Rajji TK, et al. Characteristics of ictal EEG in magnetic seizure therapy at various stimulation frequencies. Clin Neurophysiol. 2018;129:1770–1779.
Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014;44:225–239.
Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, et al. Right unilateral ultrabrief pulse ECT in geriatric depression: phase 1 of the PRIDE study. Am J Psychiatry. 2016;173:1101–1109.
Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68:568–577.
Kessler U, Schoeyen HK, Andreassen OA, Eide GE, Malt UF, Oedegaard KJ, et al. The effect of electroconvulsive therapy on neurocognitive function in treatment-resistant bipolar disorder depression. J Clin Psychiatry. 2014;75:e1306–1313.
Polster JD, Kayser S, Bewernick BH, Hurlemann R, Schlaepfer TE. Effects of electroconvulsive therapy and magnetic seizure therapy on acute memory retrieval. J ECT. 2015;31:13–19.
Funding and disclosure
The authors thank the clinical research staff and the patient participants of the study. In the last 5 years, ZJD has received research and equipment in-kind support for an investigator-initiated study through Brainsway Inc and Magventure Inc. His work was supported by the Ontario Mental Health Foundation, the Canadian Institutes of Health Research (CIHR), the National Institutes of Mental Health, and the Temerty Family and Grant Family and through the Centre for Addiction and Mental Health (CAMH) Foundation and the Campbell Institute. During the past five years, BHM has received: research funding from Brain Canada, the CAMH Foundation, the CIHR, and the US National Institutes of Health (NIH); research support from Bristol-Myers Squibb (medications for a NIH-funded clinical trial), Eli-Lilly (medications for a NIH-funded clinical trial), Pfizer (medications for a NIH-funded clinical trial), Capital Solution Design LLC (software used in a study funded by CAMH Foundation), and HAPPYneuron (software used in a study funded by Brain Canada). He directly own stocks of General Electric (<$5,000). DMB has received research support from CIHR, NIH, Brain Canada and the Temerty Family through the CAMH Foundation and the Campbell Research Institute. He receives research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. and he is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also receives in-kind equipment support from Magventure for an investigator-initiated study. He received medication supplies for an investigator-initiated trial from Indivior. SMM has received research support from the NIH. He has received teaching honorarium from TMS Health Solutions. He is a consultant to Pearson. DV has received research training fellowship funding from the Ontario Mental Health Foundation, the APA Eli Lilly research fellowship and a CAMH Postdoctoral Fellowship, and support from the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario. JD reports research grants from CIHR, the National Institute of Mental Health, Brain Canada, the Canadian Biomarker Integration Network in Depression, the Ontario Brain Institute, the Weston Foundation, the Klarman Family Foundation, the Arrell Family Foundation, and the Buchan Family Foundation, travel stipends from Lundbeck and ANT Neuro, in-kind equipment support for investigator-initiated trials from MagVenture, and is an advisor for BrainCheck, TMS Neuro Solutions, and Restorative Brain Clinics. TKR has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, CIHR, Centre for Aging and Brain Health Innovation, NIH, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. PBF is supported by a Practitioner Fellowship grant from National Health and Medical Research Council (1078567). In the last 3 years PBF has received equipment for research from Magventure A/S, Medtronic Ltd, Neurosoft and Brainsway Ltd. He has served on a scientific advisory board for Bionomics Ltd and LivaNova and is a founder and director of TMS Australia. YK has nothing to disclose. DG has nothing to disclose. ACHW has nothing to disclose. JD (Julia Dimitrova) has nothing to disclose. YS has nothing to disclose.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Daskalakis, Z.J., Dimitrova, J., McClintock, S.M. et al. Magnetic seizure therapy (MST) for major depressive disorder. Neuropsychopharmacol. 45, 276–282 (2020) doi:10.1038/s41386-019-0515-4
Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study
The American Journal of Geriatric Psychiatry (2019)