Comparative efficacy and cognitive safety of magnetic seizure therapy and electroconvulsive therapy in major depressive disorder: a systematic review and meta-analysis.

BACKGROUND

Major depressive disorder (MDD) necessitates treatments that balance efficacy with tolerability. Electroconvulsive therapy (ECT) is highly effective but limited by cognitive side effects. Magnetic seizure therapy (MST), a more focal convulsive therapy, may offer a superior safety profile. This systematic review and meta-analysis directly compares the efficacy and cognitive safety of MST and ECT for MDD.

METHODS

We systematically searched PubMed, Embase, Cochrane CENTRAL, Web of Science, WanFang, and CNKI (inception to Nov 2025) for randomized and non-randomized controlled studies comparing MST and ECT in adults with MDD. Primary outcomes were antidepressant response and depression score changes. Secondary outcomes included cognitive function, reorientation time, and adverse events. Pooled effect estimates (RR, SMD, MD, OR) with 95% CIs were calculated.

RESULTS

13 studies (N = 607 participants) were included. MST and ECT demonstrated comparable clinical response (RR = 1.10, 95% CI: 0.94-1.27) and remission (RR = 1.04, 95% CI: 0.72-1.50) rates. Post-sensitivity analysis favored ECT for depression score change (SMD = 0.36, p=0.0001). MST was superior in preserving cognitive function (SMD = 1.19, p=0.005), enabling faster reorientation (MD=-16.72 min, p<0.00001), and reducing overall adverse event risk (OR = 0.23, p<0.00001), notably for memory loss, headache, and muscle pain. Seizure durations were shorter with MST.

CONCLUSIONS

While MST and ECT had comparable response and remission rates, sensitivity analysis of depression score changes suggested potential superiority of ECT, warranting cautious interpretation. MST provided significantly better cognitive safety and tolerability, including fewer cognitive adverse events and faster reorientation. These findings support MST as a valuable alternative for MDD patients, especially when cognitive side effects are a primary concern.This systematic review and meta-analysis was conducted and reported in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (23).

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261277041, identifier CRD420261277041.