214. Magnetic seizure therapy for major depressive disorder: clinical efficacy, safety, and prefrontal activation measured by functional near-infrared spectroscopy

Abstract

Abstract Background Magnetic seizure therapy (MST) is an emerging convulsive neuromodulation technique that may achieve antidepressant efficacy comparable to electroconvulsive therapy (ECT) while minimizing cognitive adverse effects. However, neurophysiological mechanisms underlying its therapeutic action remain incompletely characterized. Aims & Objectives To evaluate the clinical efficacy and safety of MST in patients with major depressive disorder (MDD) and to assess treatment-related cerebral hemodynamic changes using functional near-infrared spectroscopy (fNIRS). Method This prospective, open-label clinical trial was conducted at the Mental Health Center, First Hospital of Hebei Medical University, Shijiazhuang, China, from January to October 2025. Sixty-four inpatients aged 18–65 years meeting ICD-10 diagnostic criteria for MDD were recruited; 58 completed the study. Thirty age-, sex-, and education-matched healthy controls (HCs) were enrolled for fNIRS comparison. Participants received six MST sessions over two weeks in addition to standard inpatient pharmacotherapy. fNIRS data from 53 cortical channels were collected at baseline and post-treatment to assess regional cerebral blood-flow changes. Depressive, anxiety, and sleep symptoms were evaluated with the 17-item Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI). Cognitive function was assessed with standardized neuropsychological tests. fNIRS analyses focused on oxyhemoglobin (OxyHb) activation across prefrontal and temporal regions. Results At baseline, patients exhibited significantly reduced prefrontal activation compared with HCs. After MST, mean (SD) HAM-D-17 scores decreased from 29.4 (3.2) to 14.3 (4.7) (P < .001), HAMA from 25.5 (5.5) to 12.1 (5.7) (P < .001), and PSQI from 15.3 (3.9) to 9.4 (2.8) (P < .001). Significant post-treatment increases in OxyHb activation were detected in the left dorsolateral prefrontal cortex (DLPFC-L; t = 2.43, P = .017) and right frontopolar area (FPA-R; t = 2.18, P = .032). Enhanced regional activation correlated negatively with depressive severity. No serious adverse events or cognitive impairments occurred. Discussion & Conclusions MST produced substantial symptomatic improvement and was well tolerated in patients with MDD. fNIRS findings demonstrated restoration of prefrontal activation—particularly within DLPFC-L and FPA-R—implicating these regions as potential therapeutic targets and biomarkers of response. fNIRS offers a practical neurophysiological tool for elucidating and monitoring MST’s antidepressant mechanisms.