Magnetic Seizure Therapy Matches ECT Remission in Depression Trial

Key Takeaways

• Magnetic seizure therapy met the prespecified non-inferiority criterion for remission, although remission was numerically higher with right unilateral ultra-brief pulse-width electroconvulsive therapy.
• Autobiographical memory worsening was observed less often with magnetic seizure therapy than with the electroconvulsive therapy comparator.
• Withdrawals due to non-serious adverse events were fewer with magnetic seizure therapy, and the authors described a more favorable cognitive safety profile.

In adults with major depressive disorder, the CREST-MST trial found remission rates of 27.8% with right unilateral ultra-brief pulse-width electroconvulsive therapy and 22.5% with magnetic seizure therapy. Although the 5.3% difference numerically favored electroconvulsive therapy, magnetic seizure therapy met the prespecified non-inferiority threshold for remission and was associated with less autobiographical memory worsening. The randomized, double-blind, parallel-group trial was conducted at three academic centres in Canada and the USA over a single treatment course.

Adults aged 18 years and older with major depressive disorder were enrolled from June 26, 2018, to March 1, 2024. Of 292 participants who entered the study, 239 were randomly assigned and three withdrew before treatment. Treatment continued until remission, dropout, or 21 sessions, with magnetic seizure therapy delivered by twin coil in a midline frontal position and compared with right unilateral ultra-brief pulse-width electroconvulsive therapy. The prespecified coprimary outcomes were remission on the 24-item Hamilton Rating Scale for Depression and autobiographical memory worsening on the Autobiographical Memory Test. The remission non-inferiority margin was 15% absolute difference, and AMT worsening was defined as a 25% reduction, equivalent to one standard deviation lower performance.

Remission occurred in 27.8% of the right unilateral ultra-brief pulse-width electroconvulsive therapy group and 22.5% of the magnetic seizure therapy group. The absolute difference was 5.3% in favor of electroconvulsive therapy, but magnetic seizure therapy met the prespecified non-inferiority criterion, with a Z-test p value of 0.048 and a 95% CI of -4.4 to 14.9. Autobiographical memory worsening occurred in 17.3% of participants receiving electroconvulsive therapy and 2.7% receiving magnetic seizure therapy, with p=0.0003. Remission was numerically higher with electroconvulsive therapy, while autobiographical memory worsening was less frequent with magnetic seizure therapy.

Withdrawals due to non-serious adverse events occurred in 12 participants assigned to right unilateral ultra-brief pulse-width electroconvulsive therapy and three assigned to magnetic seizure therapy. Enrollment concluded before the intended sample size was reached. People with lived experience were not directly involved in study design, although researchers said indirect feedback and clinical discussions informed the work. The authors characterized magnetic seizure therapy as having non-inferior efficacy relative to right unilateral ultra-brief pulse-width electroconvulsive therapy and a more favorable cognitive safety profile.