PT  - JOURNAL ARTICLE
AU  - Victor M. Tang
AU  - Daniel M. Blumberger
AU  - Julia Dimitrova
AU  - Alanah Throop
AU  - Shawn M. McClintock
AU  - Daphne Voineskos
AU  - Jonathan Downar
AU  - Yuliya Knyahnytska
AU  - Benoit H. Mulsant
AU  - Paul B. Fitzgerald
AU  - Zafiris J. Daskalakis
TI  - Magnetic seizure therapy is efficacious and well tolerated for treatment-resistant bipolar depression: an open-label clinical trial
AID  - 10.1503/jpn.190098
DP  - 2020 Sep 01
TA  - Journal of Psychiatry and Neuroscience
PG  - 313--321
VI  - 45
IP  - 5
4099  - http://jpn.ca/content/45/5/313.short
4100  - http://jpn.ca/content/45/5/313.full
SO  - J Psychiatry Neurosci2020 Sep 01; 45
AB  - Background: Treatment-resistant bipolar depression can be treated effectively using electroconvulsive therapy, but its use is limited because of stigma and cognitive adverse effects. Magnetic seizure therapy is a new convulsive therapy with promising early evidence of antidepressant effects and minimal cognitive adverse effects. However, there are no clinical trials of the efficacy and safety of magnetic seizure therapy for treatment-resistant bipolar depression.Methods: Participants with treatment-resistant bipolar depression were treated with magnetic seizure therapy for up to 24 sessions or until remission. Magnetic seizure therapy was applied over the prefrontal cortex at high (100 Hz; n = 8), medium (50 or 60 Hz; n = 9) or low (25 Hz; n = 3) frequency, or over the vertex at high frequency (n = 6). The primary outcome measure was the 24-item Hamilton Rating Scale for Depression. Participants completed a comprehensive battery of neurocognitive tests.Results: Twenty-six participants completed a minimally adequate trial of magnetic seizure therapy (i.e., ≥ 8 sessions), and 20 completed full treatment per protocol. Participants showed a significant reduction in scores on the Hamilton Rating Scale for Depression. Adequate trial completers had a remission rate of 23.1% and a response rate of 38.5%. Per-protocol completers had a remission rate of 30% and a response rate of 50%. Almost all cognitive measures remained stable, except for significantly worsened recall consistency on the autobiographical memory inventory.Limitations: The open-label study design and modest sample size did not allow for comparisons between stimulation parameters.Conclusion: In treatment-resistant bipolar depression, magnetic seizure therapy produced significant improvements in depression symptoms with minimal effects on cognitive performance. These promising results warrant further investigation with larger randomized clinical trials comparing magnetic seizure therapy to electroconvulsive therapy.Clinical trial registration NCT01596608; clinicaltrials.gov