Treatment-resistant depression, or TRD, is exactly what it sounds like: a form of mental illness that challenges effective therapy. This is not uncommon, with around 3 million people in the United States suffering from TRD.

In a new study, published in the October 19, 2021 online issue of The Journal of Clinical Psychiatry, an international team of scientists led by senior author Zafiris J. Daskalakis, MD, PhD, professor of psychiatry and chair of the Department of Psychiatry at the University of San Diego School of Medicine, investigated whether magnetic therapy continues (STD) could effectively prevent relapse of TRD, particularly compared to what is known about electroconvulsive therapy (ECT), the current standard of care but a method with mixed results and a controversial history.

ECT is a procedure, performed under general anesthesia, in which small electrical currents pass through the brain, triggering a brief seizure and changes in brain chemistry that reverse symptoms of certain mental health problems, including depression and depression. mania.

ECT dates back to the 1930s. Early treatments involved large doses of electricity given without anesthesia, causing memory loss, fractures, and other serious side effects. Contemporary ECT uses much lower levels of electrical stimulus in combination with anesthesia to avoid pain and muscle relaxants to reduce the physical dangers of a seizure.

ECT often works when other treatments fail, but it doesn’t work for everyone and some side effects can still occur, such as confusion and memory loss. These concerns, and a lingering public stigma, have limited its widespread use.

STD is a different form of electrical brain stimulation, which debuted in the late 1990s. It induces a seizure in the brain by delivering high intensity magnetic field pulses through a magnetic coil. Stimulation can be narrowly focused on one region of the brain, with minimal effect on surrounding tissue and fewer cognitive side effects. Like ECT, STD is being studied for the treatment of depression, psychosis, and obsessive-compulsive disorder.

Although ECT and, to a lesser extent, STD, have both shown in previous research to produce immediate benefit in the treatment of at least some cases of acute or treatment-resistant depression, we much less is known about whether continuing the STD could prevent relapse of mental illness.

In the latest study, the first of its kind, Daskalakis and colleagues investigated whether continued STD use prevented a recurrence of treatment-resistant major depressive disorder (unipolar) or bipolar depression, which includes symptoms of mania. .

Researchers enrolled participants with eligible diagnoses who responded well to an acute course of STDs to receive a continuation course of STDs. Between February 2012 and June 2019, 30 participants received 12 continuation MST sessions with decreasing frequency over a six-month period.

One third of patients experienced a relapse of depression or had to be hospitalized in psychiatry, with no significant difference between those with unipolar and bipolar depression. However, the other two-thirds maintained improvements in depressive symptoms without any adverse cognitive effects.

The authors noted that the relapse rate for continuous STD was lower than previous research evaluating acute point STD: 33% versus 50%. They also observed that those who had suicidal ideation improved with the acute STD had a sustained resolution of these symptoms throughout the continuation of the STD. Most neurocognitive tests showed no significant difference during the pursuit of the STD. Indeed, verbal fluency has improved. These results also show that additional STD treatments repeated over a long period of time continued to be a safe and tolerable procedure.

The size of the study was small, the authors said, but the results are encouraging enough to conduct larger-scale clinical trials, especially comparing the effectiveness of STD to ECT.


Journal reference:

Tang, VM, et al. (2021) Continuation magnetic therapy for treatment-resistant unipolar or bipolar depression. The Journal of Clinical Psychiatry.

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