Reduction of suicidality with high-frequency vertex magnetic seizure therapy in treatment-resistant depression: A pooled secondary analysis

Background Magnetic seizure therapy (MST) is novel treatment for severe depression, which is associated with fewer cognitive side effects than electroconvulsive therapy (ECT). Evidence suggests anti-suicidal effects; however, influence of stimulation parameters and patient characteristics remains unclear. Methods Data of 38 patients with treatment-resistant depression (TRD) receiving high-frequency (100 Hz) MST over vertex in an open-label trial were pooled. Suicidality was assessed pre- versus post-treatment using suicide-specific items from Hamilton Rating Scale for Depression (HRSD-3), Montgomery–Åsberg Depression Rating Scale (MADRS-10), Beck Depression Inventory (BDI-9), and Inventory of Depressive Symptomatology–Self-Report (IDS-SR-18). Associations with anxiety (HAMA), anhedonia (SHAPS), and depressive response were examined. In 10 patients, within-session effects were measured using HRSD-3 and Depression and Anxiety Cognitive Scale item 6 (DACS-6). Results At baseline, 89.5% (34/38) reported suicidality; 76.5% (26/34) achieved remission after MST. HRSD-3 scores decreased from 1.71 ± 0.76 to 0.55 ± 0.68 (F(1,33) = 51.30, p < 0.001), with large effects for MADRS-10, BDI-9, and IDS-SR-18. In subsample, DACS-6 scores showed main effect of time (F(2, 18) = 5.12, p = 0.017), suggesting reduced suicidal urge within hours. These analyses were exploratory in nature and based on a small subsample; therefore, findings should be interpreted cautiously. Conclusions High-frequency vertex MST produced robust reductions in suicidality in TRD, with high remission rates and with exploratory evidence of early within-session changes in suicidal ideation. Findings support further randomized trials to confirm efficacy and to evaluate MST alongside established interventions such as ECT or ketamine.