MST: Cochrane Database Review
Out on PubMed, from researchers in China, is this review:
Magnetic seizure therapy for treatment-resistant depression.
Cochrane Database Syst Rev. 2021 Jun 16;6:CD013528. doi: 10.1002/14651858.CD013528.pub2.PMID: 34131914
The abstract is copied below:
Background: Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT). Reports to date on use of MST for patients with treatment-resistant depression (TRD) are limited.
Objectives: To evaluate the effects of MST in comparison with sham-MST, antidepressant, and other forms of electric or magnetic treatment for adults with TRD.
Search methods: In March 2020, we searched a wide range of international electronic sources for published, unpublished, and ongoing studies. We hand-searched the reference lists of all included studies and relevant systematic reviews and conference proceedings of the Annual Meeting of the American College of Neuropsychopharmacology (ACNP), the Annual Scientific Convention and Meeting, and the Annual Meeting of the European College of Neuropsychopharmacology (ECNP) to identify additional studies.
Selection criteria: All randomised clinical trials (RCTs) focused on MST for adults with TRD.
Data collection and analysis: Two review authors extracted data independently. For binary outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we estimated mean differences (MDs) between groups and 95% CIs. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using the GRADE approach. Our main outcomes of interest were symptom severity, cognitive function, suicide, quality of life, social functioning, dropout for any reason, serious adverse events, and adverse events that led to discontinuation of treatment.
Main results: We included three studies (65 participants) comparing MST with ECT. Two studies reported depressive symptoms with the Hamilton Rating Scale for Depression (HAMD). However, in one study, the data were skewed and there was an imbalance in baseline characteristics. Analysis of these two studies showed no clear differences in depressive symptoms between treatment groups (MD 0.71, 95% CI -2.23 to 3.65; 2 studies, 40 participants; very low-certainty evidence). Two studies investigated multiple domains of cognitive function. However most of the outcomes were not measured by validated neuropsychological tests, and many of the data suffered from unbalanced baseline and skewed distribution. Analysis of immediate memory performance measured by the Wechsler Memory Scale showed no clear differences between treatment groups (MD 0.40, 95% CI -4.16 to 4.96; 1 study, 20 participants; very low-certainty evidence). Analysis of delayed memory performance measured by the Wechsler Memory Scale also showed no clear differences between treatment groups (MD 2.57, 95% CI -2.39 to 7.53; 1 study, 20 participants; very low-certainty evidence). Only one study reported quality of life, but the data were skewed and baseline data were unbalanced across groups. Analysis of quality of life showed no clear differences between treatment groups (MD 14.86, 95% CI -42.26 to 71.98; 1 study, 20 participants; very low-certainty evidence). Only one study reported dropout and adverse events that led to discontinuation of treatment. Analysis of reported data showed no clear differences between treatment groups for this outcome (RR 1.38, 95% CI 0.28 to 6.91; 1 study, 25 participants; very low-certainty evidence). Adverse events occurred in only two participants who received ECT (worsening of preexisting coronary heart disease and a cognitive adverse effect). None of the included studies reported outcomes on suicide and social functioning. No RCTs comparing MST with other treatments were identified.
Authors' conclusions: Evidence regarding effects of MST on patients with TRD is currently insufficient. Our analyses of available data did not reveal clearly different effects between MST and ECT. We are uncertain about these findings because of risk of bias and imprecision of estimates. Large, long, well-designed, and well-reported trials are needed to further examine the effects of MST.
And from the text:
Despite our comprehensive search, we identified only a small body of evidence. This systematic review included three studies, and pooling of data from these studies was not possible due to skewed data, unbalanced baseline characteristics, and invalidity of measures. Included studies reported only short-term outcomes; therefore, medium- and long-term effects of MST remain unknown. In addition, none of these studies provided information related to suicides, suicide attempts, self-harm, or social functioning. In summary, reporting was incomplete.
...Given that research is insufficient to show whether MST is effective for TRD, further research is needed to address this question. All RCTs should report the standards required by CONSORT (an evidence-based, minimum set of recommendations for reporting randomised trials; www.consortstatement.org). To be more specific, methods of randomisation and allocation concealment, along with attrition with corresponding reasons, should be reported. Studies should be conducted and outcomes reported according to the protocol. A double-masked approach should be taken to reduce detection and performance bias. Studies with a large sample size can improve precision; validated tests are essential to determine the true cognitive effects. Exploration of effects of MST on suicide and social functioning will enhance our understanding of this novel treatment. It is important that future researchers seek to evaluate longer-term outcomes. Separate reports of unipolar and bipolar TRD may help reduce heterogeneity. Comparators other than ECT may further reveal the effects of MST. In addition, current reports of MST are limited geographically. Therefore, research should be conducted in non-Western countries with a clear description of location provided for local healthcare users, healthcare providers, and policymakers.
This is a very long run for a very short slide. The abstract and above text tell the whole (short) story. MST may be interesting, but the apparatus is complicated and expensive; IMO is is unclear if MST will ever evolve into a useful clinical treatment.
At the risk of (again) being labeled a Luddite, I think efforts to remove barriers to access to ECT are more likely to have public health benefits than continuing to follow the trail of MST.
Feel free to read all 42 pages of the Cochrane review, but I do not recommend that, and I withhold any kudos.
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