Continuation Magnetic Seizure Therapy for Treatment-Resistant Unipolar or Bipolar Depression

Victor M. Tang, MD, MSc, FRCPC^a ; Daniel M. Blumberger, MD, MSc, FRCPC^a,b ; Alanah Throop, MPsy^a ; Shawn M. McClintock, PhD^c,d ; Daphne Voineskos, MD, PhD, FRCPC^a,b ; Jonathan Downar, MD, PhD, FRCPC^b,e ; Yuliya Knyahnytska, MD, PhD, FRCPC^a ; Benoit H. Mulsant, MD, PhD, FRCPC^a,b ; Paul B. Fitzgerald, MBBS, MPM, PhD^f ; Zafiris J. Daskalakis, MD, PhD^a,b,g

J Clin Psychiatry 2021;82(6):20m13677

ABSTRACT

Objective: Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression (TRD) but may be associated with adverse cognitive effects. Magnetic seizure therapy (MST) is a promising alternative convulsive treatment with a safer cognitive profile. Although there is emerging evidence for the efficacy of MST for TRD as an acute treatment, there are no published studies of continuation MST for the prevention of relapse.

Methods: Patients with TRD with a DSM-IV diagnosis of major depressive disorder or bipolar disorder who met response criteria after acute MST were offered continuation MST in a prospective, open-label trial between February 2012 and June 2019. They received 12 continuation MST sessions with decreasing frequency over the course of 6 months, with additional booster sessions if their depression symptoms started to worsen. The primary outcome was relapse of depression or psychiatric hospitalization. Secondary outcomes included relapse of suicidal ideation and neurocognitive outcomes.

Results: Thirty participants completing at least one assessment during continuation MST were included in the analysis; 10 (33.3%) relapsed, with no significant differences in survival distributions between unipolar and bipolar groups (χ² = 0.3, P = .58). Mean (SD) survival time was 18.6 (1.6) weeks. All 17 participants who achieved resolution of baseline suicidality after acute MST remained free of suicidality during the continuation phase. Except for improvement in verbal fluency, neurocognitive test scores did not change during continuation MST.

Conclusions: During 6 months of continuation MST, two-thirds of participants sustained improvements in depressive symptoms without any adverse cognitive effects. Future studies of continuation MST are warranted, particularly in comparison to ECT.

Trial Registration: ClinicalTrials.gov identifier: NCT01596608

Continue Reading...

Members enjoy unlimited free PDF downloads as part of their subscription! Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Buy PDF for $40

Please sign in or purchase this PDF for $40.

References (43)

Ghaemi SN, Rosenquist KJ, Ko JY, et al. Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatry. 2004;161(1):163–165. PubMed CrossRef
Rush AJ, Trivedi MH, Wisniewski SR, 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(11):1905–1917. PubMed CrossRef
Voineskos D, Daskalakis ZJ, Blumberger DM. Management of treatment-resistant depression: challenges and strategies. Neuropsychiatr Dis Treat. 2020;16:221–234. PubMed CrossRef
Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357(19):1939–1945. PubMed CrossRef
Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568–577. PubMed CrossRef
Lisanby SH, Luber B, Schlaepfer TE, et al. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology. 2003;28(10):1852–1865. PubMed CrossRef
McClintock SM, Tirmizi O, Chansard M, et al. A systematic review of the neurocognitive effects of magnetic seizure therapy. Int Rev Psychiatry. 2011;23(5):413–423. PubMed CrossRef
Kirov G, Ebmeier KP, Scott AI, et al. Quick recovery of orientation after magnetic seizure therapy for major depressive disorder. Br J Psychiatry. 2008;193(2):152–155. PubMed CrossRef
Fitzgerald PB, Hoy KE, Elliot D, 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(5):393–401. PubMed CrossRef
Deng Z-D, 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(1):016007. PubMed CrossRef
Lee WH, Lisanby SH, Laine AF, et al. Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model. Eur Psychiatry. 2016;36:55–64. PubMed CrossRef
Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285(10):1299–1307. PubMed CrossRef
Kellner CH, Knapp RG, Petrides G, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry. 2006;63(12):1337–1344. PubMed CrossRef
Nordenskjöld A, von Knorring L, Ljung T, et al. Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: a randomized controlled trial. J ECT. 2013;29(2):86–92. PubMed CrossRef
Navarro V, Gastó C, Torres X, et al. Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study. Am J Geriatr Psychiatry. 2008;16(6):498–505. PubMed CrossRef
Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013;38(12):2467–2474. PubMed CrossRef
Kellner CH, Husain MM, Knapp RG, et al; CORE/PRIDE Work Group. A novel strategy for continuation ECT in geriatric depression: phase 2 of the PRIDE study. Am J Psychiatry. 2016;173(11):1110–1118. PubMed CrossRef
Kayser S, Bewernick BH, Matusch A, et al. Magnetic seizure therapy in treatment-resistant depression: clinical, neuropsychological and metabolic effects. Psychol Med. 2015;45(5):1073–1092. PubMed CrossRef
Daskalakis ZJ, Dimitrova J, McClintock SM, et al. Magnetic seizure therapy (MST) for major depressive disorder. Neuropsychopharmacology. 2020;45(2):276–282. PubMed CrossRef
Tang VM, Blumberger DM, Dimitrova J, et al. Magnetic seizure therapy is efficacious and well tolerated for treatment-resistant bipolar depression: an open-label clinical trial. J Psychiatry Neurosci. 2020;45(5):313–321. PubMed CrossRef
Hamilton M. Rating depressive patients. J Clin Psychiatry. 1980;41(12 pt 2):21–24. PubMed
First MH, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders—Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 1990.
First M, Spitzer R, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II). New York: Biometric Research Department; 1994.
Oquendo MA, Baca-Garcia E, Kartachov A, et al. A computer algorithm for calculating the adequacy of antidepressant treatment in unipolar and bipolar depression. J Clin Psychiatry. 2003;64(7):825–833. PubMed CrossRef
Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–583. PubMed CrossRef
Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343–352. PubMed CrossRef
Young RC, Biggs JT, Ziegler VE, et al. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133(5):429–435. PubMed CrossRef
McElhiney M, Moody B, Sackeim H. The Autobiographical Memory Interview-Short form. New York: Department of Biological Psychiatry: New York State Psychiatric Institute; 2001.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. PubMed CrossRef
Partington JE, Leiter RG. Partington’s Pathways Test. Psychol Serv Cent J. 1949;1:11–20.
Golden CJ, Freshwater SM. Stroop Color and Word Test. 1978. https://link.springer.com/referenceworkentry/10.1007%2F978-0-387-79948-3_660
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Oxford University Press; 1998.
Nuechterlein KH, Green MF. MATRICS Consensus Cognitive Battery Manual. Los Angeles, CA: MATRICS Assessment Inc; 2006.
Polster JD, Kayser S, Bewernick BH, et al. Effects of electroconvulsive therapy and magnetic seizure therapy on acute memory retrieval. J ECT. 2015;31(1):13–19. PubMed CrossRef
Sun Y, Blumberger DM, Mulsant BH, et al. Magnetic seizure therapy reduces suicidal ideation and produces neuroplasticity in treatment-resistant depression. Transl Psychiatry. 2018;8(1):253. PubMed CrossRef
Patel RS, Bachu A, Youssef NA. Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States. Brain Stimul. 2020;13(1):15–19. PubMed CrossRef
Prudic J, Haskett RF, McCall WV, et al. Pharmacological strategies in the prevention of relapse after electroconvulsive therapy. J ECT. 2013;29(1):3–12. PubMed CrossRef
Elias A, Phutane VH, Clarke S, et al. Electroconvulsive therapy in the continuation and maintenance treatment of depression: systematic review and meta-analyses. Aust N Z J Psychiatry. 2018;52(5):415–424. PubMed CrossRef
Sackeim HA, Prudic J, Devanand DP, et al. The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression. J Clin Psychopharmacol. 1990;10(2):96–104. PubMed CrossRef
Sackeim HA, Prudic J, Devanand DP, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57(5):425–434. PubMed CrossRef
Omori W, Itagaki K, Kajitani N, et al. Shared preventive factors associated with relapse after a response to electroconvulsive therapy in four major psychiatric disorders. Psychiatry Clin Neurosci. 2019;73(8):494–500. PubMed CrossRef
Semkovska M, McLoughlin DM. Measuring retrograde autobiographical amnesia following electroconvulsive therapy: historical perspective and current issues. J ECT. 2013;29(2):127–133. PubMed CrossRef
Kessler U, Schoeyen HK, Andreassen OA, et al. The effect of electroconvulsive therapy on neurocognitive function in treatment-resistant bipolar disorder depression. J Clin Psychiatry. 2014;75(11):e1306–e1313. PubMed CrossRef