Cognitive Preservation and Antidepressant Efficacy of Magnetic Seizure Therapy in Adolescent Treatment Resistant Major Depressive Disorder in China: A Randomized Controlled Trial.

ObjectiveTo compare the antidepressant efficacy, cognitive impact, and safety profile of magnetic seizure therapy (MST) vs modified electroconvulsive therapy (MECT) in Chinese adolescents with treatment-resistant major depressive disorder (MDD).MethodsThis single-center, evaluator-blinded, prospective randomized controlled trial enrolled 120 adolescents aged 13-18 years diagnosed with treatment-resistant MDD. Participants were randomly assigned to either the MST group or the MECT group (n = 60 per group). The primary outcome was improvement in depressive symptoms measured by the Beck Depression Inventory-II (BDI-II) score reduction rate. Secondary outcomes included changes in cognitive function assessed by the Montreal Cognitive Assessment (MoCA), time to reorientation, and adverse event incidence per CTCAE 5.0 criteria.ResultsThe BDI-II reduction rate was significantly higher in the MECT group (51.8%) compared to the MST group (46.5%) (P < 0.001), though clinical response rates were similar (90.0% vs 91.1%). The MST group showed significant improvement in MoCA total score, whereas the MECT group demonstrated slight declines (P < 0.001). MST was associated with greater cognitive preservation (+0.96 vs -0.36 MoCA score), fewer adverse events (28.9% vs 64.0%, P < 0.001), and faster reorientation (6.9 ± 1.8 min vs 18.7 ± 6.8 min, P < 0.001).ConclusionMST exhibited comparable antidepressant efficacy to MECT while offering superior cognitive protection and safety in adolescents with treatment-resistant MDD. These findings suggest MST may be a preferred treatment option balancing symptom relief with neurodevelopmental preservation.