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