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Peterchev AV, Deng ZD, Sikes-Keilp C, Feuer EC, Rosa MA, Lisanby SH. Optimal Frequency for Seizure Induction With Electroconvulsive Therapy and Magnetic Seizure Therapy in Nonhuman Primates. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2025; 5:100471. [PMID: 40213706 PMCID: PMC11985115 DOI: 10.1016/j.bpsgos.2025.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/27/2024] [Accepted: 02/11/2025] [Indexed: 04/16/2025] Open
Abstract
Background Electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) are effective in the treatment of medication-resistant depression. Determining the stimulus frequency that results in the lowest seizure threshold could produce fewer adverse effects by reducing the overall stimulus intensity. Methods To determine the optimal frequency for seizure induction, 4 male rhesus macaques were titrated with an increasing number of pulses at fixed frequencies ranging from 5 to 240 pulses per second (pps) using ultrabrief pulse right-unilateral ECT and circular-coil-on-vertex MST. Bilateral electroencephalography was recorded to characterize the seizure expression. Results The seizure threshold dependence on stimulus frequency was similar for ECT and MST. While higher frequencies required progressively shorter trains to induce a seizure, the middle frequency range was associated with the fewest pulses (and therefore the least charge and energy), with a minimum at 16 pps and similarly low thresholds for 10 and 25 pps. The number of pulses at seizure threshold increased markedly at lower and higher frequencies. The lowest stimulus frequencies, 5 and 10 pps, were associated with the greatest ictal power measured by electroencephalography. Conclusions While neither efficacy nor side effects were assessed in this study, the results highlight the significance of stimulus frequency for seizure induction, suggest efficient titration schedules that minimize exposure to the electrical stimulus, and can inform studies to assess the impact on clinical outcomes. These data can also support safety guidelines for interventions such as transcranial magnetic stimulation that must avoid seizure induction.
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Affiliation(s)
- Angel V. Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Christopher Sikes-Keilp
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Elyssa C. Feuer
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Moacyr A. Rosa
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Institute for Advanced Research in Neurostimulation, São Paulo, São Paulo, Brazil
| | - Sarah H. Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Neufeld NH, Blumberger DM. An Update on the Use of Neuromodulation Strategies in the Treatment of Schizophrenia. Am J Psychiatry 2025; 182:332-340. [PMID: 40165555 DOI: 10.1176/appi.ajp.20250068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
The field of neuromodulation has evolved tremendously and now includes a vast array of interventions utilizing different technologies that span electrical, magnetic, and ultrasound forms of stimulation. The evolution of interventions holds the promise of fewer adverse effects and a noninvasive approach, increasing the scale at which these interventions may be offered in hospital and community settings. While the majority of neuromodulation studies have focused on patients with mood disorders, predominantly depression, there is an unmet need for patients with schizophrenia, who are in dire need of novel therapeutic options. Advances in neuroimaging and approaches for examining individual variability and transdiagnostic symptoms may lead to more effective neuromodulation treatments in this patient population. This overview explores the modern landscape of invasive and noninvasive neuromodulation treatments for patients with schizophrenia. It begins with approaches that involve diffuse stimulation of the cortex and subcortex and then reviews more focal stimulation approaches at the cortical and subcortical levels. The authors also reflect on the relationship between our understanding of the neurobiology of schizophrenia and neuromodulation interventions.
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Affiliation(s)
- Nicholas H Neufeld
- Kimel Family Translational Imaging-Genetics Laboratory (Neufeld), Campbell Family Mental Health Research Institute (Neufeld, Blumberger), Schizophrenia Division (Neufeld), and Temerty Centre for Therapeutic Brain Intervention (Neufeld, Blumberger), Centre for Addiction and Mental Health (CAMH), Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto (Neufeld, Blumberger)
| | - Daniel M Blumberger
- Kimel Family Translational Imaging-Genetics Laboratory (Neufeld), Campbell Family Mental Health Research Institute (Neufeld, Blumberger), Schizophrenia Division (Neufeld), and Temerty Centre for Therapeutic Brain Intervention (Neufeld, Blumberger), Centre for Addiction and Mental Health (CAMH), Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto (Neufeld, Blumberger)
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Goodman MS, Trevizol AP, Konstantinou GN, Boivin-Lafleur D, Brender R, Downar J, Kaster TS, Knyahnytska Y, Vila-Rodriguez F, Voineskos D, Daskalakis ZJ, Blumberger DM. Extended course accelerated intermittent theta burst stimulation as a substitute for depressed patients needing electroconvulsive therapy. Neuropsychopharmacology 2025; 50:685-694. [PMID: 39443721 PMCID: PMC11845777 DOI: 10.1038/s41386-024-02007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 10/03/2024] [Accepted: 10/08/2024] [Indexed: 10/25/2024]
Abstract
In response to restrictions on electroconvulsive therapy (ECT) access during COVID-19, we designed a trial to assess the clinical outcomes service impacts, employing an extended course of accelerated intermittent theta burst stimulation (aiTBS), in patients with moderate to severe depression in need of ECT. This open label clinical trial was comprised of 3 phases: (i) an acute phase, where iTBS treatments were administered 8 times daily, for up to 10 days; (ii) a tapering phase of 2 treatment days per week for 2 weeks, followed by 1 treatment day per week for 2 weeks; and (iii) a symptom-based relapse prevention phase, whereby treatments were scheduled based on symptom re-emergence, for up to 6 months. Of the 155 patients who completed the acute phase of the study, the remission rate was 16.1%. The mean reduction from baseline on the HRSD-24 was 29.4% (p < 0.001) and the response rate was 25.2%. Of the 110 patients who completed the tapering phase, the mean reduction from baseline was 42.6% (p < 0.001) and response and remission rates were 49.6% and 34.8%, respectively. Of the 61 patients who were eligible for the relapse prevention phase, 43 completed, with a mean reduction from baseline of 60.1% (p < 0.001); 7 patients relapsed during this phase. This study demonstrated that an extended aiTBS protocol safely led to meaningful clinical outcomes in patients with severe depression, who otherwise would have received ECT, and thus reduced pressure on ECT services during the pandemic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04384965 ( https://clinicaltrials.gov/study/NCT04384965?term=NCT04384965&rank=1 ).
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Affiliation(s)
- Michelle S Goodman
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gerasimos N Konstantinou
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ram Brender
- Royal Ottawa Mental Health Centre and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | | | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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McClintock SM, Deng ZD, Husain MM, Thakkar VJ, Bernhardt E, Weiner RD, Luber B, Lisanby SH. Comparing the Neurocognitive Effects of Right Unilateral Ultra-Brief Pulse Electroconvulsive Therapy and Magnetic Seizure Therapy for the Treatment of Major Depressive Episode. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2025; 10:175-185. [PMID: 39515580 DOI: 10.1016/j.bpsc.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/22/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Magnetic seizure therapy (MST) is under investigation as a treatment for adults with major depression. Previous research has suggested that MST has antidepressant efficacy comparable to that of 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 the outcomes of those receiving ECT for the treatment of major depressive episode. METHODS This was a between-subjects, double-masked, randomized, multicenter clinical trial. Seventy-three participants with a severe major depressive episode were enrolled and randomly assigned to treatment with MST (n = 35) or ultra-brief pulse right unilateral ECT (n = 38). The main outcome was change in performance from baseline to the end of acute treatment on multiple neurocognitive measures. RESULTS Compared with patients who received ECT, patients who received MST had superior cognitive outcomes up to 72 hours posttreatment. Specifically, following MST treatment, there was significant improvement in fine motor dexterity (p = .017) and no significant change in cognitive domains of attention, verbal fluency, executive function, or verbal learning and memory. In contrast, following treatment with ECT, patients demonstrated significantly worse performance on measures of verbal fluency (p < .001), executive function (p = .038), and verbal memory retention (p < .001). Autobiographical memory consistency decreased significantly following treatment with both ECT (p < .001) and MST, although the magnitude of change was greater for ECT. CONCLUSIONS The study findings confirm previous work and provide new evidence supporting the enhanced cognitive safety of MST relative to ECT. Future research on MST is warranted to optimize its application to individuals with neuropsychiatric illnesses across the life span.
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Affiliation(s)
- Shawn M McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas; Perot Foundation Neuroscience Translational Research Center, O'Donnell Brain Institute, UT Southwestern Medical Center, Dallas, Texas.
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mustafa M Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Vishal J Thakkar
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Elisabeth Bernhardt
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard D Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Ren C, Kung S, Croarkin PE, Opitz A, Forester BP, Hermida AP, Mueller M, Pagali SR, Petrides G, Seiner SJ, Yoon IA, Lapid MI. Optimizing Electroconvulsive Therapy With E-Field Modeling: A Narrative Review. J ECT 2025:00124509-990000000-00250. [PMID: 39853304 DOI: 10.1097/yct.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2025]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in treatment-resistant cases. However, its potential cognitive side effects necessitate careful dosing to balance therapeutic benefits and cognitive stability. Recent advances in electric field (E-field) modeling offer promising avenues to optimize ECT dosing. This review synthesizes current knowledge on E-field modeling in ECT and explores its clinical applications. It examines the variability in E-field strengths and distributions induced by ECT and their impact on clinical outcomes. Additionally, the relationship between E-field strengths, neuroplasticity, and therapeutic efficacy is discussed. Translational studies of E-field-informed ECT are highlighted, emphasizing individualized optimal amplitude dosing and potential clinical applications. This review provides useful insights into how E-field modeling can improve the effectiveness of ECT while minimizing adverse effects, helping guide future research and clinical practice.
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Affiliation(s)
- Caili Ren
- Department of Rehabilitation Medicine, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Simon Kung
- From the Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Paul E Croarkin
- From the Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | | | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Martina Mueller
- College of Nursing, Department of Public Health Sciences Medical University of South Carolina, Charleston, SC
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Isabel A Yoon
- From the Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Maria I Lapid
- From the Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
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Shi ZM, Su ZA, Ning T, Zheng W. Magnetic seizure therapy versus electroconvulsive therapy for major mental disorders: A systematic review. Asian J Psychiatr 2025; 103:104336. [PMID: 39689575 DOI: 10.1016/j.ajp.2024.104336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 11/21/2024] [Accepted: 11/30/2024] [Indexed: 12/19/2024]
Affiliation(s)
- Zhan-Ming Shi
- Chongqing Jiangbei Mental Health Center, Chongqing, China
| | - Zhi-Ang Su
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Ting Ning
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Cavenaghi VB, Carneiro AM, Cretaz E, Cabral B, Cardoso CB, Brunoni AR. Magnetic seizure therapy for unipolar and bipolar depression: An up to date systematic review. World J Biol Psychiatry 2025; 26:49-59. [PMID: 39710605 DOI: 10.1080/15622975.2024.2439897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 11/20/2024] [Accepted: 12/05/2024] [Indexed: 12/24/2024]
Abstract
BACKGROUND Magnetic seizure therapy (MST) has emerged as a promising alternative to electroconvulsive therapy (ECT) for treatment-resistant depression. Previous systematic reviews and meta analysis already showed its primary results, however, there are no recent reviews updating these findings. OBJECTIVES This systematic review aimed to make an updated systematic review of MST on unipolar and bipolar depression. METHODS We conducted a search considering databases (PubMed/MEDLINE, EMBASE, Web of Science, Scopus). Studies were included if they investigated MST in human subjects for unipolar or bipolar depression, and not restricting to year or language. RESULTS Data resulted in 15 studies, corresponding to 300 participants that received MST. Most studies were pilot, open-label or secondary analyses (n = 12). Participants that received MST had a response and remission rates ranging from 26.9% to 72.2% and 11.1% to 61.1%, respectively. The most common stimulation regions were vertex and prefrontal cortex, with frequencies between 25-100 Hz and duration of 6-24 sessions (2-3 times a week). Few side effects were reported. CONCLUSIONS MST shows to be effective and well-tolerated treatment for depression. Larger, double-blinded RCTs with standardised mood, cognitive, and side effect assessments are needed to confirm these findings.
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Affiliation(s)
- Vitor Breseghello Cavenaghi
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Adriana M Carneiro
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Eric Cretaz
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Bianca Cabral
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Caroline Benigno Cardoso
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Prillo J, Zapf L, Espinola CW, Daskalakis ZJ, Blumberger DM. Magnetic Seizure Therapy in Refractory Psychiatric Disorders: A Systematic Review and Meta-Analysis: La thérapie par convulsions magnétiques pour la prise en charge des troubles psychiatriques réfractaires : revue systématique et méta-analyse. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241301005. [PMID: 39654297 PMCID: PMC11629361 DOI: 10.1177/07067437241301005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
ObjectiveTo qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders.MethodsA literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for "magnetic seizure therapy." Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes.ResultsA total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, P = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, P < 0.005). It is suggested that MST has modest cognitive side effects.ConclusionsLarge-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.
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Affiliation(s)
- Jake Prillo
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lorina Zapf
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Caroline W. Espinola
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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Zilles-Wegner D, Kellner CH, Sartorius A. Electroconvulsive Therapy and Its New Competitors: ECT Remains the Gold Standard. J ECT 2024; 40:e31-e32. [PMID: 38968450 DOI: 10.1097/yct.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Affiliation(s)
- David Zilles-Wegner
- From the Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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10
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Liu X, Wang H. Neuromodulations in Psychiatric Disorders: Emerging Lines of Definition. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 94:31-39. [PMID: 39541960 PMCID: PMC11797915 DOI: 10.1159/000542163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 10/17/2024] [Indexed: 11/17/2024]
Affiliation(s)
- Xiaolei Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Psychosomatic Disease Consultation Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Psychosomatic Disease Consultation Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Kiebs M, Farrar DC, Yrondi A, Cardoner N, Tuovinen N, Redlich R, Dannlowski U, Soriano-Mas C, Dols A, Takamiya A, Tendolkar I, Narr KL, Espinoza R, Laroy M, van Eijndhoven P, Verwijk E, van Waarde J, Verdijk J, Maier HB, Nordanskog P, van Wingen G, van Diermen L, Emsell L, Bouckaert F, Repple J, Camprodon JA, Wade BSC, Donaldson KT, Oltedal L, Kessler U, Hammar Å, Sienaert P, Hebbrecht K, Urretavizcaya M, Belge JB, Argyelan M, Baradits M, Obbels J, Draganski B, Philipsen A, Sartorius A, Rhebergen D, Ousdal OT, Hurlemann R, McClintock S, Erhardt EB, Abbott CC. Electroconvulsive therapy and cognitive performance from the Global ECT MRI Research Collaboration. J Psychiatr Res 2024; 179:199-208. [PMID: 39312853 PMCID: PMC11869118 DOI: 10.1016/j.jpsychires.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/03/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
The Global ECT MRI Research Collaboration (GEMRIC) has collected clinical and neuroimaging data of patients treated with electroconvulsive therapy (ECT) from around the world. Results to date have focused on neuroimaging correlates of antidepressant response. GEMRIC sites have also collected longitudinal cognitive data. Here, we summarize the existing GEMRIC cognitive data and provide recommendations for prospective data collection for future ECT-imaging investigations. We describe the criteria for selection of cognitive measures for mega-analyses: Trail Making Test Parts A (TMT-A) and B (TMT-B), verbal fluency category (VFC), verbal fluency letter (VFL), and percent retention from verbal learning and memory tests. We performed longitudinal data analysis focused on the pre-/post-ECT assessments with healthy comparison (HC) subjects at similar timepoints and assessed associations between demographic and ECT parameters with cognitive changes. The study found an interaction between electrode placement and treatment number for VFC (F(1,107) = 4.14, p = 0.04). Higher treatment was associated with decreased VFC performance with right unilateral electrode placement. Percent retention showed a main effect for group, with post-hoc analysis indicating decreased cognitive performance among the HC group. However, there were no significant effects of group or group interactions observed for TMT-A, TMT-B, or VFL. We assessed the current GEMRIC cognitive data and acknowledge the limitations associated with this data set including the limited number of neuropsychological domains assessed. Aside from the VFC and treatment number relationship, we did not observe ECT-mediated neurocognitive effects in this investigation. We provide prospective cognitive recommendations for future ECT-imaging investigations focused on strong psychometrics and minimal burden to subjects.
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Affiliation(s)
- Maximilian Kiebs
- Department of Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University of Oldenburg, Oldenberg, Germany; Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
| | - Danielle C Farrar
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Toulouse, France; Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Narcis Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Noora Tuovinen
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Redlich
- Department of Psychology, University of Halle, Germany; Institute of Translational Psychiatry, University of Muenster, Germany; Halle-Jena-Magdeburg, German Center for Mental Health (DZPG), Germany
| | - Udo Dannlowski
- Institute of Translational Psychiatry, University of Muenster, Germany
| | - Carles Soriano-Mas
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, Universitat de Barcelona - UB, Barcelona, Spain
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam UMC location, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Akihiro Takamiya
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katherine L Narr
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Maarten Laroy
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esmée Verwijk
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, UMC Amsterdam, Amsterdam, the Netherlands; ECT-Department, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | | | - Joey Verdijk
- Department of Psychiatry, Rijnstate, Arnhem, the Netherlands
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry in Linköping, Linköping, Sweden
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC location, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience Amsterdam, the Netherlands
| | - Linda van Diermen
- Department of Psychiatry, University Hospital of Liège, Liege, Belgium; Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Emsell
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Geriatric Psychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Geriatric Psychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Jonathan Repple
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Joan A Camprodon
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin S C Wade
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - K Tristan Donaldson
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Skåne, Sweden
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Kaat Hebbrecht
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Mikel Urretavizcaya
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Neurosciences Group - Psychiatry and Mental Health, Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Jean-Baptiste Belge
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Miklos Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Mate Baradits
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Bogdan Draganski
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Didericke Rhebergen
- Department of Psychiatry, Amsterdam UMC location, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; GGZ Central, Mental Health Institute, Amersfoort, the Netherlands
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Norway
| | - René Hurlemann
- Department of Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University of Oldenburg, Oldenberg, Germany
| | - Shawn McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Christopher C Abbott
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Peterchev AV, Deng ZD, Sikes-Keilp C, Feuer EC, Rosa MA, Lisanby SH. Optimal Frequency for Seizure Induction with Electroconvulsive Therapy and Magnetic Seizure Therapy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.28.615333. [PMID: 39803550 PMCID: PMC11722405 DOI: 10.1101/2024.09.28.615333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
Electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) are effective in the treatment of medication-resistant depression. Determining the stimulus frequency resulting in the lowest seizure threshold could produce fewer adverse effects by reducing the overall stimulus intensity. To determine the optimal frequency for seizure induction, four male rhesus macaques were titrated with an increasing number of pulses at fixed frequencies ranging from 5 to 240 pulses per second (pps) using ultrabrief-pulse right-unilateral ECT and circular-coil-on-vertex MST. The seizure threshold dependence on stimulus frequency was similar for ECT and MST. While higher frequencies required progressively shorter trains to induce a seizure, the middle frequency range was associated with the fewest pulses (and hence the least charge and energy), with a minimum at 16 pps and similarly low thresholds for 10 and 25 pps. The number of pulses at seizure threshold increased markedly at lower and higher frequencies. The lowest stimulus frequencies, 5 and 10 pps, were associated with the greatest ictal power measured by electroencephalography. While this study did not assess efficacy or side effects, the results highlight the significance of stimulus frequency for seizure induction, suggest efficient titration schedules that minimize exposure to the electrical stimulus, and can inform studies to assess the impact on clinical outcomes.
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McCall WV, George MS, Sackeim HA. Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode. JAMA Psychiatry 2024; 81:736-737. [PMID: 38656342 DOI: 10.1001/jamapsychiatry.2024.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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14
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Deng ZD, Weiner RD, Lisanby SH. Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode-Reply. JAMA Psychiatry 2024; 81:737-738. [PMID: 38656323 DOI: 10.1001/jamapsychiatry.2024.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Richard D Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
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Nordenskjöld A, Popiolek K, Kellner CH. Magnetic vs Electric Seizure Induction for the Treatment of Mania-Similar, But Not Yet the Same. JAMA Netw Open 2024; 7:e247892. [PMID: 38683613 DOI: 10.1001/jamanetworkopen.2024.7892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Affiliation(s)
- Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Katarzyna Popiolek
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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16
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Chen S, Sheng J, Yang F, Qiao Y, Wang W, Wen H, Yang Q, Chen X, Tang Y. Magnetic Seizure Therapy vs Modified Electroconvulsive Therapy in Patients With Bipolar Mania: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e247919. [PMID: 38683612 PMCID: PMC11059045 DOI: 10.1001/jamanetworkopen.2024.7919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/22/2024] [Indexed: 05/01/2024] Open
Abstract
Importance 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. Objective To compare the effectiveness and cognitive adverse effects of MST and ECT in bipolar mania. Design, Setting, and Participants 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. Interventions 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. Main Outcomes and Measures 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. Results 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. Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT03160664.
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Affiliation(s)
- Shan Chen
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Jianhua Sheng
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuzhong Yang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzheng Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wen
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiao Yang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Chen
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Neuroimaging Core, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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