Magnetic Seizure Therapy Rivals ECT, Protects Cognition in Adolescent MDD

A recent study showed that magnetic seizure therapy offered comparable efficacy to modified electroconvulsive therapy (ECT) with superior cognitive protection and safety in adolescents with major depressive disorder (MDD).1

“While [ECT] outperformed [magnetic seizure therapy] in BDI-II reduction…reflecting its rapid antidepressant action, [magnetic seizure therapy’s] superiority in cognitive preservation – evidenced by [Montreal Cognitive Assessment] total score improvement…and specific gains in memory, orientation, and executive function – highlights its potential to safeguard neurodevelopment in this vulnerable group,” wrote investigator Wei Wang, from Shandong Mental Health Center, and colleagues.

ECT is an effective, often lifesaving treatment for MDD but can cause cognitive side effects like memory impairment, which may be especially harmful to adolescents. Conversely, magnetic seizure therapy uses high-frequency magnetic stimulation to induce seizures while sparing deeper brain structures, like the hippocampus, potentially reducing cognitive effects. Early studies suggest magnetic seizure therapy provides similar efficacy to ECT with less cognitive impact, though adolescent data remain limited.2,3

Investigators conducted a prospective, assessor-blinded randomized controlled trial between March 1 and April 30, 2025, at Shandong Mental Health Center to compare magnetic seizure therapy with modified ECT for adolescent MDD in terms of cognitive protection and suicidality improvement.1The primary outcome was the Beck Depression Inventory-II (BDI-II) percentage reduction, and secondary outcomes included Montreal Cognitive Assessment scores (total score and subdomains of visuospatial/executive function, naming, attention, language, abstraction, memory, orientation), Columbia-Suicide Severity Rating Scale, and adverse events per CTCAE 5.0, and reorientation time. Investigators assessed these outcomes at baseline and 7 days post-treatment.

The sample included 120 adolescents aged 13 – 18 years with treatment-resistant MDD (baseline BDI-II ≥ 29). The study excluded participants with comorbid bipolar disorder or schizophrenia, intracranial metal implants, epilepsy, severe physical illness, or prior exposure to either therapy.

Investigators randomized participants 1:1 to receive magnetic seizure therapy (n = 60; mean age, 15.15 years; 78.33% females) or modified ECT (n = 60; mean age, 15.20 years; 80% females) for 12 – 16 sessions, 3 times weekly. Magnetic seizure therapy used the NS7000 device with stimulation at the Cz position, 100 Hz frequency, 100% intensity, and 8 – 10 seconds per second. Meanwhile, the modified ECT used the Thymatron System IV, with bilateral stimulation dosed according to age. Participants received anesthesia (propofol 1.5 – 20 mg and succinylcholine 0.5 mg/kg) and continued SSRIs without benzodiazepines or mood stabilizers.

Modified ECT led to greater BDI-II reductions (51.8% vs 46.5%; P <.001), with similar response rates between treatments (90.0% vs 91.1%; P =.081). However, magnetic seizure therapy showed significant improvements in the total cognitive score (difference, 1.32; 95% confidence interval [CI], 0.92 – 1.70; P <0.001), especially in memory (difference, 1.20; 95% CI, 0.99 – 1.41; P <.001), orientation (difference, 0.66; 95% CI, 0.45 – 0.87; P <.001), and executive function subdomains (difference, 0.50; 95% CI, 0.35 – 0.65; P <.001). The study reported lower subjective cognitive complaints in the magnetic seizure therapy arm (20% vs 62%; P <.001).1

Magnetic seizure therapy also improved suicidality outcomes more effectively (4.91±0.29 to 0.78±0.90 vs. 4.98±0.14 to 1.12±0.69; P =.036), with a greater remission rate (33.3% vs. 16.0%; P =.044). The study found no significant group difference regarding severity scores (P =.310).1

Investigators observed a stronger correlation between Montreal Cognitive Assessment change and suicidality improvement in magnetic seizure therapy (95% CI, 0.48 – 0.74, P < .001) vs 95% CI, 0.14 – 0.58; P =.008). The mediation analysis demonstrated a partial mediating role of Montreal Cognitive Assessment improvement in magnetic seizure therapy (95% CI, 0.10 - 0.54; P =.004).1

Safety findings favored magnetic seizure therapy, with fewer adverse events (28.9% vs 64.0%; P <.001) and shorter reorientation time (6.9±1.8 vs 18.7±6.8 minutes; P <.001). Adverse events included short-term memory loss (20.0% vs. 62.0%; P <.001) and nausea (6.7% vs. 32.0%, P <.001).1

“[Magnetic seizure therapy] offers a balanced treatment for adolescent MDD, matching [modified ECT’s] antidepressant efficacy while excelling in cognitive protection and suicidality reduction,” investigators concluded.1 “The mediating role of cognitive improvement suggests a novel mechanism, positioning [magnetic seizure therapy] as a promising option for preserving neurodevelopment and mitigating suicide risk. Long-term, multicenter trials are needed to optimize its clinical application.”

References

1. Wang W, Lu Y, Mi GL, Li XJ, Zhang DN, Qi SF. Cognitive preservation advantage and efficacy balance of magnetic seizure therapy in adolescent Major Depressive Disorder: a randomized controlled trial revealing efficacy cognition decoupling phenomenon. Riv Psichiatr. 2025;60(5):196-201. doi:10.1708/4583.45901

2. Chen S, Sheng J, Yang F, et al. Magnetic Seizure Therapy vs Modified Electroconvulsive Therapy in Patients With Bipolar Mania: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(4):e247919. Published 2024 Apr 1. doi:10.1001/jamanetworkopen.2024.7919

3. Deng ZD, Luber B, McClintock SM, Weiner RD, Husain MM, Lisanby SH. Clinical Outcomes of Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode: A Randomized Clinical Trial. JAMA Psychiatry. 2024;81(3):240-249. doi:10.1001/jamapsychiatry.2023.4599