- Design
- Double-blind, randomised, parallel-group pilot trial
- Population
- 55 randomised adults with bipolar depression; 45 had an adequate trial
- Primary outcome
- Remission on the 24-item Hamilton scale, and autobiographical memory decline
- Effect
- Remission 30% (ECT) vs 20% (MST); memory decline of 25% or more in 22.2% vs 7.1%
This double-blind pilot randomised 55 people with bipolar depression to right unilateral ultrabrief ECT or magnetic seizure therapy, given until remission, dropout or 21 treatments. Primary outcomes were remission on the 24-item Hamilton scale and a decline in autobiographical memory.
Of the 45 who had an adequate trial, 6 of 20 (30%) on ECT and 5 of 25 (20%) on magnetic seizure therapy reached remission. A clinically important memory decline (25% or more on the Autobiographical Memory Test) occurred in 6 of 27 (22.2%) on ECT and 2 of 28 (7.1%) on magnetic seizure therapy. Secondary clinical outcomes were similar.
The sample was too small to test non-inferiority, and remission rates were low in both arms. Magnetic seizure therapy is available in few centres. The finding is a reason to expect larger trials, not to change referral now.
- ECT remains the established option for severe or treatment-resistant bipolar depression.
- When cognitive side effects are the barrier to ECT, mention that magnetic seizure therapy is under study.
- Document autobiographical memory concerns before and during any convulsive therapy.
- Treat the pilot's remission figures as imprecise; both arms had low remission.
Why it matters
Fear of memory loss limits ECT uptake, and this is an early sign that a different seizure induction might ease it.
Don't overread it
A pilot of this size cannot show that magnetic seizure therapy matches ECT or is safer.
The statistics, in plain English
With 20 to 25 people per arm, a 10-point difference in remission (30% vs 20%) is well within chance, and the study was not powered to prove two treatments equal. Such differences tell you what to test next, not which treatment is better.
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