Magnetic Seizure Therapy Research Articles

Comparing the Neurocognitive Effects of Right-Unilateral Ultra-Brief Pulse Electroconvulsive Therapy and Magnetic Seizure Therapy for the Treatment of Major Depressive Episode

Magnetic seizure therapy (MST) is under investigation as a treatment for adults with major depression. Prior research suggested that MST has comparable antidepressant efficacy with electroconvulsive therapy (ECT), but with greater cognitive safety. The objective of the study was to compare the neurocognitive outcomes of patients receiving an acute course of MST with those receiving ECT for the treatment of major depressive episode. This was a between-subject, double-masked, randomized, multi-center clinical trial. Seventy-three participants with a severe major depressive episode were enrolled and randomly assigned to treatment with MST (N = 38) or ultra-brief pulse right unilateral ECT (N = 35). The main outcomes were change in performance from baseline to end of acute treatment on multiple neurocognitive measures. Patients receiving MST, relative to those receiving ECT, had superior cognitive outcomes up to 72-hours post-treatment. Specifically, following MST treatment, there was significant improvement in fine motor dexterity (p=0.017) and no significant change in cognitive domains of attention, verbal fluency, executive function, and verbal learning and memory. In contrast, following treatment with ECT, patients demonstrated significantly worsened performance on measures of verbal fluency (p<0.001), executive function (p=0.038), and verbal memory retention (p<0.001). Autobiographical memory consistency significantly decreased following treatment with both ECT (p<0.001) and MST, though the magnitude of change was greater for ECT. The study findings confirm prior work and provide new evidence supporting the enhanced cognitive safety of MST relative to ECT. Future research is warranted on MST to optimize its application in individuals across the lifespan with neuropsychiatric illnesses. ClinicalTrials.gov identifier: NCT00488748.

Fluctuations in resting motor threshold during electroconvulsive and magnetic seizure therapy

Objectives Magnetic seizure therapy (MST) is more benign than electroconvulsive therapy (ECT) in terms of cognitive impairment. However, whether these two ‘artificial seizures’ facilitate the central motor neural pathway and the motor cortical effects have not been investigated. The study aimed to compare the effects of ECT and MST on motor-evoked potential (MEP) in patients with mental disorders. Methods Forty-nine patients with mental disorders (major depressive disorder, bipolar disorder type II and schizophrenia [SCZ]) received 6 treatment sessions of vertex MST versus 6 bifrontal ECT treatments in a nonrandomized comparative clinical design. Data on the duration of motor seizures were collected for each treatment. MEP latency and the resting motor threshold (rMT) were measured at baseline and after every two treatments. Comparisons were performed between or within the groups. Results Seizure durations were significantly longer in the ECT group compared to the MST group across multiple sessions. Both MST and ECT demonstrated a significant reduction in rMT in the left and right hemispheres after the fourth (T3) and sixth treatments (T4) compared to baseline (T1). However, there were no significant changes in MEP latency within or between the groups throughout the treatment sessions. The only difference was that the rMT in the left cerebral hemisphere was significantly lower after T4 than after the second treatment (T2). There was no difference in rMT between the ECT and MST groups. Conclusions Both ECT and MST facilitate the central motor pathway, with a shared mechanism of increased motor cortex excitability.

Does Electroencephalography Seizure Duration Account for an Adequate Treatment of Magnetic Seizure Therapy for Schizophrenia?

A seizure lasting >15 s has been considered to indicate treatment for magnetic seizure therapy (MST), a modification of electroconvulsive therapy (ECT), without much validation. This study aimed to investigate whether this seizure duration was suitable for the treatment of schizophrenia. Altogether, 34 and 33 in-patients with schizophrenia received 10 sessions of MST and ECT, respectively. Clinical symptoms were assessed using the Positive and Negative Symptom Scale at baseline and at the 4-week follow-up. Electroencephalogram (EEG) was monitored during each MST or ECT treatment using bifrontal electrodes. The proportion of participants who achieved the 15-second threshold was only 28.6% in the MST group, with a significant difference between responders and nonresponders. For patients receiving MST, the average EEG seizure duration correlated with the percentage of Positive and Negative Symptom Scale reduction (t(32) = 2.51, P = 0.017, uncorrected; t(32) = 2.00, P = 0.055, corrected with clinical characteristics). The average EEG seizure duration predicted the clinical response at a trend level (Z = 1.76, P = 0.078) with an optimal cutoff of 11.3 seconds. All patients in the ECT group achieved the 15-second threshold. However, their average EEG seizure duration was uncorrelated with clinical improvement. The duration of EEG seizures may be associated with the antipsychotic effects of MST. This association may have been influenced by various clinical and technical factors. More research is needed to define the specific criteria for adequate MST in schizophrenia in order to achieve personalized dosing.

Magnetic Seizure Therapy in Management of Depression: A Narrative Review

Magnetic Seizure Therapy in Management of Depression: A Narrative Review

Role of Electroconvulsive Therapy and Transcranial Magnetic Stimulation in Treatment-Resistant Depression

Electroconvulsive therapy (ECT) is one of the oldest known psychiatric treatments in modern times. It preceded modern pharmacotherapy for mood disorders and continues to play a major role in treatment-resistant depression (TRD). Its proven efficacy has been the inspiration behind the continued advancements in the field of neurostimulation. Electroconvulsive therapy, vagus nerve stimulation, and repetitive transcranial magnetic stimulation (rTMS), are currently approved by the US Food and Drug Administration (FDA) as neurostimulation modalities for TRD. Other modalities of neurostimulation such as transcranial direct current stimulation, deep brain stimulation, and magnetic seizure therapy have been studied and used, but are not yet FDA approved. In this article, we will focus on two modalities that are widely used and available to patients: ECT and rTMS. While both treatments are recommended for TRD, either alone or in conjunction with other treatments, they vary widely in their safety profile and treatment protocol, which impacts both patient selection and public perception. [ Psychiatr Ann . 2024;54(6):e164–e169.]

Magnetic Seizure Therapy vs Modified Electroconvulsive Therapy in Patients With Bipolar Mania

Bipolar mania is a common disabling illness. Electroconvulsive therapy (ECT) is an effective treatment for patients with severe mania, though it is limited by the risk of cognitive adverse effects. Magnetic seizure therapy (MST) as an alternative treatment to ECT for bipolar mania has not yet been reported. To compare the effectiveness and cognitive adverse effects of MST and ECT in bipolar mania. This randomized clinical trial was conducted at the Shanghai Mental Health Center from July 1, 2017, through April 26, 2021. Forty-eight patients with bipolar mania were recruited and randomly allocated to receive MST or ECT. The data analysis was performed from June 5, 2021, through August 30, 2023. Patients completed 2 or 3 sessions of MST or ECT per week for a total of 8 to 10 sessions. The MST was delivered at 100% device output with a frequency of 75 Hz over the vertex. The primary outcomes were reduction of total Young Manic Rating Scale (YMRS) score and response rate (more than 50% reduction of the total YMRS score compared with baseline). An intention-to-treat (ITT) analysis and repeated-measures analyses of variance were conducted for the primary outcomes. Twenty patients in the ECT group (mean [SD] age, 31.6 [8.6] years; 12 male [60.0%]) and 22 patients in the MST group (mean [SD] age, 34.8 [9.8] years; 15 male [68.2%]) were included in the ITT analysis. The response rates were 95.0% (95% CI, 85.4%-100%) in the ECT group and 86.4% (95% CI, 72.1%-100%) in the MST group. The YMRS reduction rate (z = -0.82; 95% CI, -0.05 to 0.10; P = .41) and response rate (χ2 = 0.18; 95% CI, -0.13 to 0.31; P = .67) were not significantly different between the groups. The time-by-group interaction was significant for the language domain (F1,24 = 7.17; P = .01), which was well preserved in patients receiving MST but worsened in patients receiving ECT. No serious adverse effects were reported in either group. These findings suggest that MST is associated with a high response rate and fewer cognitive impairments in bipolar mania and that it might be an alternative therapy for the treatment of bipolar mania. ClinicalTrials.gov Identifier: NCT03160664.

Brain-Computer Interface Based Neuromodulation on Treatment of Depression

Major Depressive Disorder (MDD) represents a significant societal burden, with traditional first-line treatments often falling short. This pressing issue has spurred the exploration of neuromodulation therapies, demonstrating superior efficacy compared to conventional pharmaceutical interventions. The present review provides a rigorous evaluation of four advanced neuromodulation techniques: Focal Electrically Administered Seizure Therapy (FEAST), Transcranial Magnetic Stimulation (TMS), Intermittent Theta-Burst Stimulation (iTBS), and Magnetic Seizure Therapy (MST). A comprehensive analytical comparison is offered, focusing on their efficacy, feasibility, economic considerations, and underlying mechanisms. Among these therapies, iTBS, integrated with Brain-Computer Interface (BCI) systems, has emerged as notably effective, with clinical trials indicating an average 80% efficacy at a reduced economic cost. FEAST and MST, supported by recent research, also exhibit strong efficacy, around 60%, although with more pronounced side effects. TMS, in contrast, exhibits a slightly reduced efficacy but is promising due to its minimal side effects. The review further delves into the transformative role of increasingly sophisticated BCI technologies in addressing previously identified challenges of neuromodulation therapy, such as adverse side effects, time-consuming procedures, and high costs. These technological advancements are elucidated, emphasizing their contribution to more precise therapy delivery and an enhanced patient experience. The review culminates in illuminating a pathway for the harmonious integration of neuromodulation therapies with traditional psychopharmacological treatments, positioning this integrative approach as a groundbreaking paradigm poised to redefine the landscape of depression treatment.

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

Electroconvulsive therapy (ECT) is highly effective and rapid in treating depression, but it carries a risk of significant cognitive adverse effects. Magnetic seizure therapy (MST), an investigational antidepressant treatment, may maintain the robust antidepressant efficacy of ECT while substantially reducing adverse effects due to its enhanced focality and weaker stimulation strength; however, previous clinical trials of MST were limited by small sample sizes. To compare the antidepressant efficacy of MST vs ultrabrief pulse right unilateral (RUL) ECT. A between-participants, double-blinded, randomized clinical trial was conducted at 3 academic hospitals from June 2007 to August 2012. Adults aged 18 to 90 years who were referred for treatment with ECT, had a major depressive episode in the context of major depressive disorder or bipolar disorder, and had a baseline 24-item Hamilton Depression Rating Scale (HDRS-24) total score of 18 or higher were included. Participants were randomly assigned 1:1 to treatment with MST or ultrabrief pulse RUL ECT. After the treatment course, patients were naturalistically followed up for up to 6 months to examine the durability of clinical effects. Treatment with MST, applied at 100 Hz at 100% of the maximum device power for 10 seconds, or ultrabrief pulse RUL ECT, applied at 6 times seizure threshold. The primary outcome was change from baseline in HDRS-24 total score, with patients followed up for up to 6 months. A reduction of at least 50% in the HDRS-24 score indicated response, and at least a 60% decrease in the HDRS-24 score and a total score of 8 or less indicated remission. Of the 73 participants (41 [56.2%] female; mean [SD] age, 48 [14.1] years), 35 were randomized to MST and 38 to ECT. Among them, 53 (72.6%) were classified as completers (29 in the MST group and 24 in the ECT group). Both MST and ECT demonstrated clinically meaningful antidepressant effects. In the intent-to-treat sample, 18 participants (51.4%) in the MST group and 16 (42.1%) in the ECT group met response criteria; 13 (37.1%) in the MST group and 10 (26.3%) in the ECT group met remission criteria. Among completers, 17 of 29 (58.6%) in the MST group and 15 of 24 (62.5%) in the ECT group met response criteria; 13 of 29 (44.8%) in the MST group and 10 of 24 (41.7%) in the ECT group met remission criteria. There was no significant difference between MST and ECT for either response or remission rates. However, the mean (SD) number of treatments needed to achieve remission was 9.0 (3.1) with MST and 6.7 (3.3) with ECT, a difference of 2.3 treatments (t71.0 = 3.1; P = .003). Both MST and ECT showed a sustained benefit over a 6-month follow-up period, again with no significant difference between them. Compared with MST, ECT had significantly longer time to orientation after treatment (threshold level: F1,56 = 10.0; P = .003) and greater severity of subjective adverse effects, particularly in the physical and cognitive domains. This randomized clinical trial found that the efficacy of MST was indistinguishable from that of ultrabrief pulse RUL ECT, the safest form of ECT currently available. These results support the continued development of MST and provide evidence for advantages relative to state-of-the-art ECT. ClinicalTrials.gov Identifier: NCT00488748.

Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity

Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical “slowing” of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.

Magnetic Waves vs. Electric Shocks: A Non-Inferiority Study of Magnetic Seizure Therapy and Electroconvulsive Therapy in Treatment-Resistant Depression.

Treatment-resistant depression (TRD), characterized by the failure to achieve symptomatic remission despite multiple pharmacotherapeutic treatments, poses a significant challenge for clinicians. Electroconvulsive therapy (ECT) is an effective but limited option due to its cognitive side effects. In this context, magnetic seizure therapy (MST) has emerged as a promising alternative, offering comparable antidepressant efficacy with better cognitive outcomes. However, the clinical outcomes and cognitive effects of MST require further investigation. This double-blinded, randomized, non-inferiority study aims to compare the efficacy, tolerability, cognitive adverse effects, and neurophysiological biomarkers of MST with bilateral ECT (BT ECT) in patients with TRD. This study will employ multimodal nuclear magnetic resonance imaging (MRI) and serum neurotrophic markers to gain insight into the neurobiological basis of seizure therapy. Additionally, neurophysiological biomarkers will be evaluated as secondary outcomes to predict the antidepressant and cognitive effects of both techniques. The study design, recruitment methods, ethical considerations, eligibility criteria, interventions, and blinding procedures are described. The expected outcomes will advance the field by offering a potential alternative to ECT with improved cognitive outcomes and a better understanding of the underlying pathophysiology of depression and antidepressant therapies.

Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis.

Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.

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

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. 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. 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. 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.

Treatment-resistant depression – is magnetic seizure therapy the novel treatment?

SUMMARYDepression has a large socioeconomic burden, affecting an estimated 280 million people worldwide. Up to 55% remain symptomatic following pharmacological and psychological treatment and may be classified as having treatment-resistant depression. This commentary assesses two treatment options for this group – electroconvulsive therapy (ECT) and a novel approach, magnetic seizure therapy (MST) – with reference to a Cochrane Review comparing the two. The Cochrane analysis showed no clear benefit for MST, but the evidence is currently insufficient to draw firm conclusions.

Magnetic seizure therapy for treatment-resistant depression: a Cochrane Review

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A feasibility trial of conjoint magnetic seizure therapy and dialectical behavior therapy for suicidal patients with borderline personality disorder and treatment-resistant depression

Non-invasive brain stimulation interventions for treating suicidal ideation in individuals with treatment-resistant depression offer the potential for new therapeutic options for patients with borderline personality disorder (BPD), a condition that responds poorly to antidepressant medications. Here we present a study to explore the application of magnetic seizure therapy (MST) in an open-label pilot trial of moderately to severely suicidal individuals with comorbid BPD and treatment-resistant depression conducted at the Centre for Addiction and Mental Health (Toronto, Canada). Using a non-randomized, case-control design, we investigated the feasibility and initial clinical effects of 5 weeks of conjoint MST and dialectical behaviour therapy (MST + DBT) compared with 5 weeks of DBT alone. Changes in primary symptom outcomes of suicidal ideation on the Modified Scale for Suicide Ideation and clinician-rated depression severity on the Hamilton Rating Scale for Depression – 24 were investigated using multilevel models. Additional outcomes included self-reported depression, BPD symptom severity and cognitive functioning. Out of 62 screened participants, n = 21 were enrolled, and N = 19 completed the intervention (n = 9 MST + DBT and n = 10 DBT only). The intervention was feasible to implement. Conjoint MST + DBT, but not DBT alone, led to a rapid, significant and clinically meaningful reduction in suicidal ideation at 5 weeks that was sustained at four-month follow-up. Conjoint MST + DBT was also associated with significant reductions in clinician-rated depression and BPD interpersonal symptom severity, but neither effect was sustained at four-month follow-up. There were no treatment-related effects on cognition. There were no treatment-related serious adverse events. These findings provide initial evidence to suggest that MST + DBT is a feasible intervention to reduce acute suicide risk in individuals with BPD and warrant further exploration in a sham-controlled randomized clinical trial. Traynor, Ruocco et al. find that the conjoint magnetic seizure therapy and dialectical behaviour therapy lead to a rapid, significant and clinically meaningful reduction in suicidal ideation in individuals with comorbid borderline personality disorder and treatment-resistant depression.

New grounds for magnetic seizure therapy

New grounds for magnetic seizure therapy

Contemporary Approaches Toward Neuromodulationof Fear Extinction and Its Underlying Neural Circuits.

Neuroscience and neuroimaging research have now identified brain nodes that are involved in the acquisition, storage, and expression of conditioned fear and its extinction. These brain regions include the ventromedial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), amygdala, insular cortex, and hippocampus. Psychiatric neuroimaging research shows that functional dysregulation of these brain regions might contribute to the etiology and symptomatology of various psychopathologies, including anxiety disorders and post traumatic stress disorder (PTSD) (Barad et al. Biol Psychiatry 60:322-328, 2006; Greco and Liberzon Neuropsychopharmacology 41:320-334, 2015; Milad et al. Biol Psychiatry 62:1191-1194, 2007a, Biol Psychiatry 62:446-454, b; Maren and Quirk Nat Rev Neurosci 5:844-852, 2004; Milad and Quirk Annu Rev Psychol 63:129, 2012; Phelps et al. Neuron 43:897-905, 2004; Shin and Liberzon Neuropsychopharmacology 35:169-191, 2009). Combined, these findings indicate that targeting the activation of these nodes and modulating their functional interactions might offer an opportunity to further our understanding of how fear and threat responses are formed and regulated in the human brain, which could lead to enhancing the efficacy of current treatments or creating novel treatments for PTSD and other psychiatric disorders (Marin et al. Depress Anxiety 31:269-278, 2014; Milad et al. Behav Res Ther 62:17-23, 2014). Device-based neuromodulation techniques provide a promising means for directly changing or regulating activity in the fear extinction network by targeting functionally connected brain regions via stimulation patterns (Raij et al. Biol Psychiatry 84:129-137, 2018; Marković et al. Front Hum Neurosci 15:138, 2021). In the past ten years, notable advancements in the precision, safety, comfort, accessibility, and control of administration have been made to the established device-based neuromodulation techniques to improve their efficacy. In this chapter we discuss ten years of progress surrounding device-based neuromodulation techniques-Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Magnetic Seizure Therapy (MST), Transcranial Focused Ultrasound (TUS), Deep Brain Stimulation (DBS), Vagus Nerve Stimulation (VNS), and Transcranial Electrical Stimulation (tES)-as research and clinical tools for enhancing fear extinction and treating PTSD symptoms. Additionally, we consider the emerging research, current limitations, and possible future directions for these techniques.

Brain stimulation treatment for bipolar disorder.

Bipolar disorders are clinically complex, chronic and recurrent disorders. Few treatment options are effective across hypomanic, manic, depressive and mixed states and as continuation or maintenance treatment after initial symptom remission. The aim of this review was to provide an up-to-date overview of research on the efficacy, tolerability and cognitive effects of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), deep brain stimulation (DBS) and vagus nerve stimulation (VNS). References included in this review were identified through multiple searches of the Embase, PubMed/MEDLINE and APA PsycINFO electronic databases for articles published from inception until February 2022. Published reviews, meta-analyses, randomised controlled trials and recent studies were prioritised to provide a comprehensive and up-to-date overview of research on brain stimulation in patients with bipolar disorders. The evidence base for brain stimulation as an add-on or alternative to pharmacological and psychological treatments in patients with bipolar disorders is limited but rapidly expanding. Brain stimulation treatments represent an opportunity to treat all bipolar disorder states, including cognitive dysfunction during euthymic periods. Whilst findings to date have been encouraging, larger randomised controlled trials with long-term follow-up are needed to clarify important questions regarding treatment efficacy and tolerability, the frequency of treatment-emergent affective switches and effects on cognitive function.

Depressive Symptom Dimensions and Response Trajectories in Electroconvulsive Therapy and Magnetic Seizure Therapy

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. Magnetic seizure therapy (MST) can potentially offer similar efficacy as ECT with fewer adverse side effects. This study investigates whether ECT and MST differentially act on depressive symptom clusters and explores clinical predictors of response.

Treatment-resistant bipolar depression: concepts and challenges for novel interventions.

Treatment-resistant bipolar depression (TRBD) has been reported in about one-quarter of patients with bipolar disorders, and few interventions have shown clear and established effectiveness. We conducted a narrative review of the published medical literature to identify papers discussing treatment-resistant depression concepts and novel interventions for bipolar depression that focus on TRBD. We searched for potentially relevant English-language articles published in the last decade. Selected articles (based on the title and abstract) were retrieved for a more detailed evaluation. A number of promising new interventions, both pharmacological and non-pharmacological, are being investigated for TRBD treatment, including ketamine, lurasidone, D-cycloserine, pioglitazone, N-acetylcysteine, angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, cyclooxygenase 2 inhibitors, magnetic seizure therapy, intermittent theta-burst stimulation, deep transcranial magnetic stimulation, vagus nerve stimulation therapy, and deep brain stimulation. Although there is no consensus about the concept of TRBD, better clarification of the neurobiology associated with treatment non-response could help identify novel strategies. More research is warranted, mainly focusing on personalizing current treatments to optimize response and remission rates.