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Magnetic Seizure Therapy-induced Mania: A Report of 2 Cases

Noda, Yoshihiro MD, PhD*†; Daskalakis, Zafiris J. MD, PhD, FRCPC*†; Fitzgerald, Paul B. MBBS, MPM, PhD, FRANZCP; Downar, Jonathan MD, PhD§; Rajji, Tarek K. MD, FRCPC*†; Blumberger, Daniel M. MD, MSc, FRCPC*†

doi: 10.1097/YCT.0000000000000145
Case Reports

Background: Magnetic seizure therapy (MST) is a novel brain stimulation modality used to treat refractory depression through the induction of seizures. It is currently being investigated as a potential alternative treatment to electroconvulsive therapy. To our knowledge, there have not been any previous reports of MST-induced mania.

Objective: We aim to describe 2 cases of patients with a major depressive episode who developed acute symptoms of mania during a course of MST.

Methods: The current report describes 2 cases of mania that occurred in the context of an ongoing open-label study of MST in treatment-resistant depression. The MST was administered 2 or 3 times per week and applied directly over the left and right dorsolateral prefrontal cortex. Treatment is administered until patients achieve remission or a maximum of 24 treatments. A MagVenture Twin coil and MST stimulator were used for treatment. The center of each coil was placed over F3 and F4 according to the 10–20 electroencephalography system.

Results: Patient 1 had developed manic symptoms precipitously after the sixth MST treatment, and patient 2 developed manic symptoms after the 23rd MST treatment. In both patients, the MST treatment course was stopped. Their manic symptoms resolved rapidly with pharmacotherapy after cessation of MST treatments.

Conclusions: As with electroconvulsive therapy, switches to mania or hypomania should be considered as potential adverse effects of MST.

From the *Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; †Campbell Family Mental Health Research Institute and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; ‡Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia; and §MRI-Guided rTMS Clinic, University Health Network, Toronto, Ontario, Canada.

Received for publication January 21, 2014; accepted March 25, 2014.

Reprints: Daniel M. Blumberger, MD, MSc, FRCPC, Temerty Centre for Therapeutic Brain Intervention, Head Late-Life Mood Disorders Clinic, Centre for Addiction and Mental Health, 1001 Queen St West, Unit 4-115, Toronto, Ontario, Canada M6J 1H4 (e-mail:

Y.N. does not have any financial disclosures. In the last 5 years, Z.J.D. received external funding through Brainsway Inc and a travel allowance through Pfizer and Merck. Z.J.D. has also received speaker funding through Sepracor Inc and AstraZeneca and served on the advisory board for Hoffmann-La Roche Limited. Z.J.D. receives research support from the Canadian Institutes of Health Research (CIHR), the Klarman Family Foundation, and the Buchan Family Foundation and equipment support in kind for an investigator-initiated study from MagVenture/Tonika. P.B.F. is supported by National Health and Medical Research Council Practitioner Fellowship. He has received equipment for research from Magventure A/S, Brainsway, Medtronic, and Cervel Neurotech and research funding from Cervel Neurotech. T.K.R. receives research support from the Brain and Behavior Research Foundation (previously known as NARSAD), Canadian Foundation for Innovation, CIHR, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, the US National Institutes of Health, and the W. Garfield Weston Foundation. D.M.B. receives research support from CIHR, Brain and Behavior Research Foundation (formerly NARSAD), Temerty Family through the Centre for Addiction and Mental Health Foundation, and the Campbell Research Institute; equipment support in kind for an investigator-initiated study from MagVenture/Tonika; and research and in-kind equipment support for an investigator-initiated study from Brainsway Ltd.

The authors have no conflicts of interest or financial disclosures to report.

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