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Magnetic seizure therapy in treatment-resistant depression: clinical, neuropsychological and metabolic effects

Published online by Cambridge University Press:  25 November 2014

S. Kayser ,
B. H. Bewernick ,
A. Matusch ,
R. Hurlemann ,
M. Soehle  and
T. E. Schlaepfer
S. Kayser
Affiliation:
Department of Psychiatry and Psychotherapy, University of Bonn, Germany
B. H. Bewernick
Affiliation:
Department of Psychiatry and Psychotherapy, University of Bonn, Germany
A. Matusch
Affiliation:
Institute of Neurosciences and Medicine (INM-2), Forschungszentrum Jülich, Germany
R. Hurlemann
Affiliation:
Department of Psychiatry and Psychotherapy, University of Bonn, Germany
M. Soehle
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany
T. E. Schlaepfer*
Affiliation:
Department of Psychiatry and Psychotherapy, University of Bonn, Germany Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, MD, USA
*
* Address for correspondence: T. E. Schlaepfer, M.D., Department of Psychiatry and Psychotherapy, University Hospital, Sigmund-Freud-Straße 25, 53105 Bonn, Germany. (Email: schlaepf@jhmi.edu)
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Abstract

Background.

Magnetic seizure therapy (MST), despite being in an early phase of clinical research, has been demonstrated to be associated with antidepressant efficacy. However, safety, tolerability and efficacy data in connection with functional brain activity from larger samples are lacking. The aim of this study was to determine clinical and cognitive effects of MST and the influence of MST on regional brain glucose metabolism.

Method.

Twenty-six patients suffering from treatment-resistant depression (TRD) underwent MST. Ten patients underwent a randomized trial and 16 patients an open-label study design. The primary outcome criterion was the severity of depressive symptoms assessed with the Hamilton Depression Rating Scale (HAMD). Depressive symptoms, tolerability and cognitive safety, along with social functioning and quality of life parameters, were assessed using various rating scales. A clinical follow-up visit 6 months following the completion of a course of MST and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) scans of 12 patients were analysed.

Results.

A significant response to MST was demonstrated by 69% of the patient sample, with 46% meeting remission criteria. Anxiety ratings were significantly reduced in responders and their quality of life was improved. Half of the responders relapsed within 6 months. No cognitive side-effects were observed. FDG-PET scans showed a metabolic increase in the frontal cortex bilaterally and a decrease in the left striatum.

Conclusions.

Robust antidepressant and anti-anxiety efficacy of MST was demonstrated, and found to be associated with localized metabolic changes in brain areas that are strongly implicated in depression. Thus, MST presents an effective, well-tolerated and safe treatment option for patients unable to respond to other forms of therapy for depression.

Keywords

Cognitionefficacymagnetic seizure therapymajor depressionpositron emission tomography
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 5 , April 2015 , pp. 1073 - 1092
Copyright
Copyright © Cambridge University Press 2014 

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