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

Shawn M McClintock; Zhi-De Deng; Mustafa M Husain; Vishal J Thakkar; Elisabeth Bernhardt; Richard D Weiner; Bruce Luber; Sarah H Lisanby

doi:10.1016/j.bpsc.2024.10.016

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

Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Nov 6:S2451-9022(24)00315-X. doi: 10.1016/j.bpsc.2024.10.016. Online ahead of print.

Authors

Shawn M McClintock¹, Zhi-De Deng², Mustafa M Husain³, Vishal J Thakkar⁴, Elisabeth Bernhardt⁵, Richard D Weiner⁶, Bruce Luber⁷, Sarah H Lisanby²

Affiliations

¹ Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Perot Foundation Neuroscience Translational Research Center, O'Donnell Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA. Electronic address: shawn.mcclintock@utsouthwestern.edu.
² Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
³ Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
⁴ Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
⁵ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
⁷ Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.

PMID: 39515580
DOI: 10.1016/j.bpsc.2024.10.016

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Clinical trial registration: ClinicalTrials.gov identifier: NCT00488748.

Keywords: Magnetic seizure therapy (MST); electroconvulsive therapy (ECT); major depression; memory; neurocognitive; neuromodulation.

Associated data

ClinicalTrials.gov/NCT00488748