Clinical trial suggests magnetic seizure therapy could expand treatment options for severe bipolar depression, with fewer side effects.
For decades, one of the most effective treatments for severe bipolar depression has been limited by concerns about its side effects.
Electroconvulsive therapy (ECT)—which intentionally induces a brief, controlled therapeutic seizure by stimulating the brain with electric currents—can be life-saving for people with severe mental illness, including bipolar depression. Yet, only a small proportion of eligible patients choose to undergo ECT, largely due to concerns about side effects including post-treatment disorientation and short-term memory loss.
Now, researchers at the UBC Faculty of Medicine and collaborating institutions across Canada have shown that a new form of brain stimulation therapy may offer a safer alternative.
The therapy, known as magnetic seizure therapy (MST), uses highly targeted magnetic pulses to stimulate the brain more precisely than ECT. In a new clinical trial, the researchers found MST produces similar improvements in severe bipolar depression to ECT, while causing far fewer side effects related to memory and cognition. The results were recently published in the American Journal of Psychiatry.
“People with severe bipolar depression are often living with profound emotional distress, and many have exhausted available treatment options,” said study co-author Dr. Fidel Vila-Rodriguez, Associate Professor of Psychiatry at the UBC Faculty of Medicine and investigator at the Djavad Mowafaghian Centre for Brain Health. “Our findings suggest MST has the potential to become an important new tool that could help more patients access effective care.”
Expanding much-needed treatment options
Bipolar disorder is a chronic mental health condition characterized by extreme changes in mood that cycle through periods of intense highs (mania) and lows (depression). Depressive episodes are a considerable challenge for people living with the condition, as they tend to last longer and are associated with a high risk of hospitalization, suicide and long-term disability.
There is a significant need for new ways to treat severe bipolar depression, particularly for patients who do not improve with medications or psychotherapy.
Like ECT, MST is performed while patients are under general anesthesia. During treatment, patients do not feel the stimulation, while magnetic coils positioned against the scalp deliver rapid pulses that induce a brief, controlled therapeutic seizure.
The pilot trial compared MST with ECT among 55 adults with bipolar depression across four Canadian academic health centres, with Dr. Vila-Rodriguez leading the Vancouver site. Participants received one of the therapies until their symptoms improved, they withdrew from the study or they completed a maximum of 21 treatments.
The findings revealed that both treatments produced similar improvements in depressive symptoms and suicidal ideation. However, participants who received MST experienced fewer memory-related side effects and recovered more quickly following treatment. Clinically meaningful memory side effects occurred in 22.2 per cent of participants receiving ECT, compared with only 7.1 per cent of those receiving MST.
Patients treated with MST also regained orientation more rapidly after therapy, with an average of seven minutes, compared with 19 minutes following ECT. Researchers observed improvements in quality of life in both treatment groups.
While the trial was a relatively small pilot, the researchers say the findings represent an important step toward expanding treatment options for severe bipolar depression. The study provides some of the strongest evidence to date supporting the use of MST in this patient population, and could help clinicians and patients feel more confident considering the therapy in the future.
“At a time when mental health systems are under enormous strain and many patients are not finding relief from existing treatments, we urgently need new options for severe bipolar depression,” said Dr. Vila-Rodriguez. “By stimulating the brain more precisely, MST appears to offer comparable levels of therapeutic benefit, while greatly reducing side effects on memory and cognition.”
This story was originally published on the Faculty of Medicine website.
