Please select the eligibility criteria that correspond to the clinical trial below.
Title: Efficacy and Tolerability of Magnetic Seizure Therapy (MST) as an Alternative to Electroconvulsive Therapy (ECT) for Treatment Resistant Depression, Schizophrenia, and Obsessive Compulsive Disorder
Brief Summary: Electroconvulsive therapy (ECT) has unparalleled efficacy in treating severe depression, and is also useful in treatment-refractory cases of schizophrenia and obsessive compulsive disorder (OCD). However, its use is limited by significant adverse effects on memory and cognition. In addition, ECT cannot be precisely targeted, since it relies on unpredictable pathways of electrical conduction through the brain. Magnetic seizure therapy (MST) is currently under investigation as a targetable, cognition-sparing alternative to ECT. MST uses magnetic fields rather than electrical stimuli for seizure induction, dramatically reducing the passage of induced current through undesired brain regions. 10 years of experimental studies have established the safety of MST in animal and human subjects. This pilot study will investigate whether MST has similar efficacy to ECT, with fewer cognitive side effects, in patients with severe depression, schizophrenia, and OCD.


Options:
A: Inclusion Criteria:

* Patient is diagnosed with a major depressive episode (MDE) according to DSM-IV Diagnosis Criteria derived from the SCID.
* Patient has not had an acceptable clinical response due to failure (resistance) with at least two treatments from different treatment categories during the current MDE.
* Patient has a score ≥ 20 on the 24-item Hamilton Rating Scale of Depression.
* Patient is able to give his informed consent to participate in this study and he is able to fulfill the requirements of the study.
* Patient is a male or nonpregnant female adequately protected from conception. Females of childbearing potential must use an acceptable method of birth control.
* Convulsive therapy clinically indicated

Exclusion Criteria:

* Patient currently has a secondary diagnosis of, or signs of, delirium, dementia, amnesia, or other cognitive disorders per DSM-IV.
* Patient has had or has currently a diagnosis of non-affective psychotic disorder per DSM-IV.
* Patient has had alcohol or substance dependence within the previous 12 months or abuse within the previous six months other than nicotine dependence or abuse.
* Patient has a history or diagnosis of clinically relevant cardiac disease.
* Patient has a history or diagnosis of clinically relevant injury or disease of the central nervous system.
* Patient has magnetic material in the head.
* Patient has implanted medical devices such as cardiac pacemaker, vagus nerve stimulator, medical pumps etc.
B: Inclusion Criteria:

* ages 18 to 85
* DSM-IV diagnosis of major depressive episode with or without psychotic features in the context of MDD or bipolar disorder; OCD or Schizophrenia
* 24-item HRSD score of ≥ 21 (for depression subjects)
* 18-item BPRS score of ≥ 37 (for schizophrenia subjects)
* Y-BOCS score of ≥ 16 (for OCD subjects)
* demonstrate capacity to give informed consent
* are a Canadian resident

Exclusion Criteria:

* have an unstable medical and/or neurological condition
* are currently pregnant or lactating
* are not considered sufficiently well to undergo general anesthesia for any reason
* have a cardiac pacemaker, cochlear implant, implanted electronic device or non-electric metallic implant
* are taking a benzodiazepine at a dose greater than lorazepam 2mg or equivalent
* are taking any non-benzodiazepine anticonvulsant
* have active substance misuse or dependence within the past 3 months
* have a current diagnosis of delirium, dementia or another cognitive disorder secondary to a general medical condition
* have a co-morbid borderline personality disorder and/or antisocial personality disorder
* have had a history of any suicide attempts in the past 6 months
C: Inclusion Criteria:

* inpatients or outpatients
* voluntary and competent to consent to treatment
* DSM-IV diagnosis of major depressive disorder, single or recurrent, without psychotic features
* have failed to achieve a clinical response to adequate treatment trials of at least two antidepressants (with adequacy established according to a predefined criterion on the Antidepressant Treatment History Form (ATHF)) or have been unable to tolerate at least two antidepressants
* have a baseline HRSD-24 score ≥ 21
* are considered to be appropriate to receive ECT as assessed by an ECT attending psychiatrist and an anaesthesiologist
* are agreeable to keeping their current antidepressant treatment constant through the duration of the study
* are able to adhere to the intervention schedule
* meet the MST safety criteria
* are on a medically acceptable form of birth control if a woman of child-bearing potential
* are a resident of Canada

Exclusion Criteria:

* have a history of DSM-IV substance dependence or abuse within the past three months
* have a concomitant major unstable medical illness
* are acutely suicidal with imminent intent
* are pregnant or intend to get pregnant during the study
* have a DSM-IV confirmed diagnosis of bipolar disorder, any psychotic disorder, obsessive compulsive disorder, or post-traumatic stress disorder (current or within the last year)
* have a DSM-IV diagnosis of borderline personality disorder as assessed by a study investigator
* have possible or probable dementia
* have failed a course of ECT within the current depressive episode
* have any significant neurological disorder or condition likely to be associated with increased intracranial pressure or cognitive impairment (e.g., a space occupying brain lesion, a history of stroke, a cerebral aneurysm, a seizure disorder, Parkinson's disease, Huntington's chorea, multiple sclerosis, head trauma with loss of consciousness for greater than or equal to five minutes)
* present with a medical condition, a medication, or a laboratory abnormality that could cause a major depressive episode or significant cognitive impairment in the opinion of the investigator (e.g., hypothyroidism with low TSH, rheumatoid arthritis requiring high dose prednisone, or Cushing's disease)
* have an intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed
* require a benzodiazepine with a dose equivalent to lorazepam 2 mg/day or higher or any anticonvulsant due to the potential of these medications to limit the efficacy of both MST and ECT
* have an inability to communicate in English fluently enough to complete the neuropsychological tests
* have a non-correctable clinically significant sensory impairment (i.e., cannot hear or see well enough to complete the neuropsychological tests)
D: Inclusion Criteria:

* Age 55-90
* Clinical diagnosis of major depressive episode, in the context of unipolar or bipolar disorder
* Willing and capable to provide informed consent
* Convulsive therapy clinically indicated
* Hamilton Rating Scale for Depression (HRSD24)≥ 20
* Mini Mental State Exam (MMSE) ≥ 24
* For outpatients: responsible adult living with the patient

Exclusion Criteria:

* Current unstable or serious medical condition, or any comorbid medical condition that substantially increases the risks of ECT (such as acute myocardial infarction, space occupying brain lesion or other cause of increased intracranial pressure, unstable aneurysm or vascular malformation, poorly controlled diabetes mellitus, carcinoma, renal failure, hepatic failure)
* History of neurological disorder, epilepsy, stroke, brain surgery, metal in the head, history of known structural brain lesion
* Presence of devices that may be affected by MST (pacemaker, medication pump, cochlear implant, implanted brain stimulator, or vagus nerve stimulator implanted)
* History of head trauma with loss of consciousness for greater than 5 minutes
* History of schizophrenia, schizoaffective disorder, or rapid cycling bipolar disorder
* History of substance abuse or dependence in past 3 months
* Failure to respond to an adequate course of ECT in the current depressive episode
* History of ECT in the past 6 months and/or failure to respond to an adequate trial of ECT lifetime
* Presence of intracardiac lines

Answer: B