Evidence map›Paper›PMID 41997695›Full record

ArticleThe lancet. Psychiatry2026

Confirmatory efficacy and safety trial of magnetic seizure therapy versus right unilateral ultra-brief electroconvulsive therapy in depression (CREST-MST): a randomised, double-blind, non-inferiority trial in Canada and the USA.

Daniel M Blumberger, Shawn M McClintock, Kevin E Thorpe, Carol A Tamminga, Karen Foley, Mustafa M Husain, Tyler S Kaster, Yuliya Knyahnytska, Daphne Voineskos, Kala J Bailey and 3 more

Erratum issued Registry-linked trialAbstract readComparative StudyEquivalence TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. Psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03191058 (Confirmatory Efficacy and Safety Trial of Magnetic Seizure Therapy for Depression), which is not on this map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03191058 nacompletednot on this map

Confirmatory Efficacy and Safety Trial of Magnetic Seizure Therapy for Depression (CREST - MST)

TypeinterventionalSponsorUniversity of Texas Southwestern Medical CenterRan2018 to 2024Enrolled239ConditionsDepression, Unipolar Depression, Treatment Resistant DepressionArmsMagnetic Seizure Therapy, Electroconvulsive Therapy
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Daniel M BlumbergerTemerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: daniel.blumberger@camh.ca.
Shawn M McClintockDepartment of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Perot Foundation Neuroscience Translational Research Center, O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Kevin E ThorpeDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Sick Children's Hospital, Toronto, ON, Canada.
Carol A TammingaDepartment of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Karen FoleyDepartment of Anesthesiology & Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Mustafa M HusainDepartment of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Tyler S KasterTemerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Yuliya KnyahnytskaTemerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Queen's University, Kingston, ON, Canada.
Daphne VoineskosTemerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Kala J BaileyDepartment of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Joshua J HubregsenDepartment of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Cory R WeissmanDepartment of Psychiatry, University of California San Diego, San Diego, CA, USA.
Zafiris J DaskalakisDepartment of Psychiatry, University of California San Diego, San Diego, CA, USA.

Funding

Confirmatory Safety and Efficacy Trial of Magnetic Seizure Therapy for DepressionR01MH112815 · NIMH · CENTRE FOR ADDICTION AND MENTAL HEALTH · PI BLUMBERGER, DANIEL M., DASKALAKIS, ZAFIRIS J. · 2017 to 2023
$7.4M
NIMH NIH HHS R01 MH112815
6 · The paper itself

Abstract

backgroundMagnetic seizure therapy (MST) is an innovative convulsive therapy that is clinically beneficial for patients with depression and has fewer cognitive adverse effects. This trial aimed to confirm the efficacy, tolerability, and cognitive safety of MST compared with right unilateral ultra-brief pulse-width (RUL-UB) electroconvulsive therapy (ECT).

methodsThis multisite randomised, double-blind, parallel-group, non-inferiority trial was conducted at three academic centres across Canada and the USA. Participants aged 18 years and older with major depressive disorder (MDD) received treatment until they achieved remission, dropped out, or up to 21 total treatments. MST was delivered using a twin coil in a midline frontal position. Remission of depression on the Hamilton Rating Scale for Depression-24 item and worsening of autobiographical memory on the Autobiographical Memory Test (AMT) were the coprimary outcomes. The non-inferiority margin was 15% absolute difference in remission rates and AMT worsening was defined as 25% reduction, corresponding to one standard deviation reduction in performance. People with lived experience were not directly involved; the study was informed by indirect feedback from previous trials and clinical discussions with people with depression who declined ECT. The trial is registered with ClinicalTrials.gov, NCT03191058.

findingsBetween June 26, 2018 and March 1, 2024, 292 participants were enrolled, of whom 239 were randomly assigned and three withdrew before treatment across study sites (RUL-UB ECT: mean age 45·5 years [SD 14·8, range 18-78], 80% White, 65 [55%] female, 54 [45%] male; MST: mean age 44·5 years [SD 13·8, range 18-75], 100 [85%] White, 70 [60%] female, 47 [40%] male). Enrolment concluded before reaching the intended sample size. The difference in remission rates was 5·3% in favour of RUL-UB ECT (27·8%) compared with MST (22·5%), establishing non-inferiority of MST (Z-test p=0·048 [95% CI -4·4 to 14·9]). More RUL-UB ECT participants had worsening autobiographical memory (17·3%) compared with MST participants (2·7%; p=0·0003). 12 participants in the RUL-UB ECT group and three participants in the MST group withdrew from treatment due to non-serious adverse events.

interpretationMST showed non-inferior efficacy relative to RUL-UB ECT in achieving remission of depression, and a more favourable cognitive safety profile. Collectively, the overall risk-benefit profile of MST supports its consideration as a first-line convulsive therapy in MDD, particularly in those who refuse RUL-UB ECT.

fundingNational Institutes of Mental Health.

Indexed as

Electroconvulsive TherapyMagnetic Field TherapyMajor Depressive DisorderAdultCanadaDouble-Blind MethodFemaleHumansMaleMiddle AgedTreatment OutcomeUnited States

Identifiers

PMID41997695
PMCPMC13157641

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.