Magnetic seizure therapy-induced mania: a report of 2 cases.
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.
Yoshihiro
Y
Noda
Zafiris J
ZJ
Daskalakis
Paul B
PB
Fitzgerald
Jonathan
J
Downar
Tarek K
TK
Rajji
Daniel M
DM
Blumberger
D000368:Aged; D001714:Bipolar Disorder / Q000209:etiology*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects* / Q000379:methods