Magnetic seizure therapy may decrease suicidality
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Magnetic seizure therapy appeared to decrease suicidality among patients with treatment-resistant depression, according to results of a nonrandomized controlled trial published in JAMA Network Open.
“Recent evidence suggests a potential role for repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation as treatments for subacute suicidal ideation through targeting of the brain region the dorsolateral prefrontal cortex,” Cory R. Weissman, MD, of the Temerty Centre for Therapeutic Brain Intervention at University of Toronto in Canada, and colleagues wrote. “Magnetic seizure therapy (MST) is another emerging brain stimulation therapy in which magnetic pulses, similar to rTMS, induce focal seizures, similar to [electroconvulsive therapy], in patients under general anesthesia. The hope for MST is to match the treatment efficacy of ECT with fewer adverse effects, because its effect is mediated by a different mechanism of action and a more focal treatment target in the brain structures.”
Although prior studies established efficacy of MST as a treatment for major depressive disorder, it remains unclear whether it has the same effects on reducing suicide as ECT.
In the current study, Weissman and colleagues aimed to determine the association between MST and suicidality among patients with treatment-resistant MDD. The investigators implemented an open-label study design featuring consecutive treatment cohorts, with consecutive groupings of 67 patients with treatment-resistant MDD and with baseline suicidality present, all of whom were given up to 24 treatments. At the end of the treatment period, follow-up occurred for 6 months. The researchers delivered MST at 100% stimulator output over the prefrontal cortex with low, moderate or high frequency. They measured suicidality remission as an end point score of zero on the Beck Scale for Suicidal Ideation and used a linear mixed model to evaluate the trajectory of these scores.
Participants received a mean of 19.5 MST treatments. Results showed 32 (47.8%) achieved remission overall. Further, remission occurred among 16 (55.2%) who received low-frequency MST, 12 (54.5%) who received moderate-frequency and four (25%) who received high frequency. According to results of the linear mixed model, there was an association of time with Beck Scale for Suicidal Ideation scores.
“These early findings suggest that approximately 50% of patients suffering from treatment-resistant depression have remission of their suicidal ideation with a course of MST," Weissman told Healio Psychiatry. "A direct comparison of these results in a trial comparing MST with ECT, the gold standard treatment in these situations, is warranted to follow-up on these exciting findings. This study is currently in the works.”