Magnetic seizure therapy

1. Introduction

Version followed: magnetic seizure therapy (MST) as delivered in the NIMH-funded CREST-MST trial (protocol: Daskalakis et al., Trials 2021, and the full protocol version 15.0, 2022; results: Blumberger, McClintock, Thorpe et al., Lancet Psychiatry 2026;13(5):376–386), with the psychotherapist's role written as [synthesis] around it. Sources for trial sites, sample size, remission, response, memory and discontinuation figures include the full protocol on ClinicalTrials.gov and two reports of the Lancet Psychiatry paper (Physician's Weekly; David Gratzer's Reading of the Week). The journal article itself is not drawn on, and NICE, MHRA and EMA status remains [uncertain].

MST is an investigational convulsive therapy. Like ECT, it deliberately induces a therapeutic seizure under general anaesthesia; unlike ECT, the seizure is triggered with rapidly repeated magnetic pulses rather than an electrical current passed through the scalp. The rationale its developers give is that magnetic fields pass through skin and skull more readily than electricity, allowing a more focal seizure that aims to keep ECT's antidepressant effect while causing fewer memory and other cognitive side effects [source: Psychiatric News 2021]. Investigators describe it as a distinct therapy with its own device, not a stronger form of TMS (McClintock: "essentially a brand-new therapy and not a modified form of TMS") [source: Psychiatric News 2021].

Origins: Harold Sackeim at Columbia conceived the idea in the early 1990s; Sarah H. Lisanby gave the first human treatment in Bern, Switzerland, in May 2000, with Thomas Schlaepfer, reported as a letter in Archives of General Psychiatry in 2001 [source: Psychiatric News 2021; Duke Scholars record of Lisanby, Schlaepfer, Fisch & Sackeim 2001]. The Toronto programme (Centre for Addiction and Mental Health, Temerty Centre) under Zafiris (Jeff) Daskalakis and later Daniel Blumberger led the Canadian trials and the confirmatory CREST-MST trial. The protocol paper names two sites, CAMH and UT Southwestern (Dallas); the full protocol (version 15.0, 2022) lists a third, the University of California, San Diego, with Blumberger as principal investigator [source: Psychiatric News 2021; Trials 2021 protocol; CREST-MST protocol v15.0].

Who delivers it. Only a convulsive-therapy team: trained study psychiatrists who give the treatment, and anaesthesiologists experienced in convulsive therapy who manage anaesthesia and the airway [source: Trials 2021 protocol]. A psychotherapist never delivers MST. This guide is written for the psychotherapist working alongside that team. For the established treatment MST is compared with, see 015 ECT (consent, capacity, legal frameworks and cognitive effects of ECT are set out there).

Regulatory status (as of October 2026).

Worldwide: the manufacturer of the only MST system (MagVenture, Denmark) stated in April 2026 that MST systems "are not approved or cleared for clinical use in any market worldwide" and that it is pursuing clearance in several markets; its device carries the US label "CAUTION, INVESTIGATIONAL DEVICE" [source: MagVenture press release, 17 April 2026; Psychiatric News 2021 on single manufacturer].
United States: investigational. The FDA issued an Investigational Device Exemption (IDE) for CREST-MST and accepted the trial in support of a future 510(k) premarket notification for depression [source: Trials 2021 protocol]. Trial consent forms state MST is not FDA-approved and is available only within research [source: CREST-MST consent form v13.0, 2022; NYSPI geriatric MST consent form 2016; UTHealth Houston trial page]. A search of FDA 510(k) listings in this review found no MST clearance [uncertain: not an exhaustive database check].
Canada: investigational; Health Canada issued an Investigational Testing Authorization for CREST-MST [source: Trials 2021 protocol].
EU and UK: no CE or UKCA marking for clinical MST use was found; the manufacturer's "not approved or cleared in any market" statement covers these markets [source: MagVenture 2026]. A search of the NICE website in October 2026 returned only NICE guidance on repetitive transcranial magnetic stimulation for depression (IPG542, HTG396) and no NICE guidance on MST. This is a search result, not a confirmed absence [uncertain]. No MHRA or EMA document on MST was found [uncertain].
Indication and ages studied: adults with non-psychotic major depressive disorder for whom convulsive therapy is being considered (CREST-MST: age 18 and over) [source: Trials 2021 protocol]; other trials have enrolled older adults with severe depression (NYSPI/Columbia) and adults aged 22–85 with bipolar depression or treatment-resistant depression (UTHealth Houston) [source: NYSPI consent form; UTHealth trial page]. Psychotic depression was excluded from CREST-MST [source: UTHealth news, April 2026]. No source opened reports use in children or adolescents.

Evidence status (descriptive, as sources report). CREST-MST was a randomised, double-blind, non-inferiority trial at three academic centres in Canada and the USA (Toronto, Dallas, San Diego) in adults with non-psychotic depression. Of 292 people enrolled, 239 were randomised. Three withdrew before treatment, so 236 were analysed (119 ECT, 117 MST). Reports giving 236 or 239 are therefore counting analysed versus randomised participants [source: Physician's Weekly 2026; Gratzer 2026]. Remission was 27.8% with right unilateral ultra-brief ECT and 22.5% with MST, a difference within the prespecified non-inferiority margin; response was similar (48% vs 47%); clinically meaningful worsening of autobiographical memory occurred in 17.3% of the ECT group and 2.7% of the MST group; 12 ECT and 3 MST participants stopped treatment because of non-serious adverse events [source: Physician's Weekly 2026; Gratzer 2026; UTHealth news 2026]. Reductions in suicidal ideation were reported as similar [source: UTHealth news 2026]. The authors acknowledge "challenges in reaching the intended sample size of 260 completers" [source: Gratzer 2026, quoting the paper]. Commentary on the ISEN site notes low remission in both arms and the need for longer cognitive follow-up. It frames MST as a possible option for non-psychotic patients who decline ECT, not as a general replacement [source: ISEN page]. Wider use "will depend upon regulatory approval, clinician training, and further studies" (study summary quoted on ISEN page). Daskalakis called the trial "an important first step toward bringing MST into wider clinical use" [source: Physician's Weekly 2026].

Core idea of how change happens. As with ECT, the therapeutic agent is the induced generalised seizure; MST's distinctive claim is that a more focal stimulus reduces cognitive cost [source: Psychiatric News 2021]. For the psychotherapist, change in the client's life also depends on what is built around the course: informed choice, safety, and psychological work that consolidates any mood improvement [synthesis].

2. Framework

The stages below follow a client's path through an MST trial as consent forms and the protocol describe it; the psychotherapist's tasks at each stage are [synthesis]. Exact visit and treatment schedules are set by each protocol and are not given here.

Stage A: Identification and referral. Goal: recognise a client for whom a convulsive-therapy assessment might be appropriate (severe or treatment-resistant depression; client fearful of or declining ECT because of memory concerns) and route them to the treating psychiatrist, who decides whether to refer to a trial. Moves on when: the psychiatrist and client agree to explore trial participation [synthesis; CREST-MST enrols people "considering brain stimulation treatment (ECT or MST) prescribed by their clinician" per consent form summary].

Stage B: Screening and consent. The trial team does a health history, physical examination, vital signs, blood tests, ECG, diagnostic interview and depression ratings; baseline includes interviews, questionnaires and about 1.5 hours of cognitive testing [source: CREST-MST consent form]. An attending ECT/MST psychiatrist judges whether the person is competent to consent; written consent precedes screening [source: Trials 2021 protocol]. In the NYSPI study a treatment-team clinician who was not a co-investigator documented capacity [source: NYSPI consent form]. Goal for the therapist: help the client understand and weigh the information and make a free choice. Moves on when: eligible, capable, consented.

Stage C: Acute course. Randomisation (in comparison trials, to MST or ECT, with client and raters blind to arm; both devices may be in the room to keep the blind); each treatment under general anaesthesia with muscle relaxation and EEG seizure monitoring, a short treatment followed by recovery; fasting beforehand and an escort home for outpatients; regular rating visits for mood, suicidality and side effects; antidepressants usually held stable and some medicines (higher-dose benzodiazepines, anticonvulsants) excluded; new medicines must be reported to the team [source: CREST-MST consent form; Trials 2021 protocol]. Goal for the therapist: steady support, monitoring, communication with the team. Treatment stops early for: marked worsening of depression on repeated ratings, clinically significant increase in suicidal ideation with intent or a suicide attempt, hypomania/mania or catatonia, serious attempts to harm others, repeated failure to induce a seizure, non-attendance, withdrawal of consent, or investigator safety judgment [source: Trials 2021 protocol]; the course also ends at remission or at the protocol's maximum [source: CREST-MST consent form].

Stage D: End of course and hand-back. Post-treatment ratings and cognitive testing shortly after the last treatment, then referral back to the treating psychiatrist [source: CREST-MST consent form; Trials 2021 protocol]. Goal for the therapist: plan continuation care with the psychiatrist and consolidate gains.

Stage E: Follow-up and continuation. Trial follow-up visits (for example at six months in CREST-MST; at about two and six months in the NYSPI study) for symptoms, suicidality, quality of life, side effects and cognition [source: CREST-MST consent form; NYSPI consent form]. The NYSPI form advises a recovery period of roughly one to three weeks after the course during which driving and major decisions should be avoided [source: NYSPI consent form]. Goal for the therapist: relapse prevention, rebuilding function, processing the experience.

3. Guiding principles

Investigational means research first, treatment second. FDA guidance asks that participants understand the main aim of a study is research, not their own care [source: FDA informed consent guidance 2023, via Hall Render summary]. Practical meaning: never describe MST as an available or proven treatment; say "a treatment being tested in trials" [synthesis].
Stay in your lane. Decisions on eligibility, anaesthesia, medicines and stopping belong to the treating team. Practical meaning: you inform, support and pass on observations; you never advise starting, stopping or changing treatment or medication [synthesis].
Consent is a process, not a signature. Consent includes information, chances to ask questions and voluntary agreement, and is updated when new information emerges [source: FDA 2023 guidance]. Practical meaning: revisit understanding across the course, not only at signing [synthesis].
Voluntariness and the right to withdraw. Participants may decline or leave at any time without losing their right to care [source: CREST-MST consent form; NYSPI consent form; FDA 2023 guidance]. Practical meaning: make it safe for the client to say no or to stop, including to you [synthesis].
Guard against undue influence. FDA guidance asks that potentially coercive situations be identified and addressed [source: FDA 2023 guidance]. Practical meaning: be aware of desperation, family pressure, a therapist's own enthusiasm, and free research care as pressures; name them [synthesis].
Report honestly what trials report. Practical meaning: give the client the trial's own risk list and results, including uncertainty and the fact that MST is less studied than ECT [source: CREST-MST consent form; synthesis].
Safety is continuous. Worsening depression and suicidality are possible during trials and are monitored at each visit [source: CREST-MST consent form]. Practical meaning: keep your own risk assessment and safety plan current and share concerns promptly with the team [synthesis].
Blinding is respected. Practical meaning: do not try to guess or uncover which arm the client is in; support them whatever the arm [synthesis].
Psychotherapy is complementary, not competing. Practical meaning: continue or adapt therapy in agreement with the team. Neither the CREST-MST protocol paper nor the full protocol (version 15.0, 2022, as far as its text could be read) sets any rule on psychotherapy. Its rules on concurrent treatment cover medicines only: the current antidepressant is kept constant, some medicines are excluded, and concomitant medicines are recorded at screening [source: Trials 2021 protocol; CREST-MST protocol v15.0]. Ask the trial team before starting a new psychological treatment or changing session frequency during the course, since such changes could affect the trial's ratings [synthesis; uncertain whether sites apply an unwritten rule].
Cognition is part of mood care. Practical meaning: adapt sessions to post-treatment tiredness or confusion and track memory complaints as information for the team [synthesis].

4. Intervention inventory

Part A describes, at a descriptive level only, how the treating team delivers MST within trials and what official trial documents say about safety. Part B is the psychotherapist's own work. Stimulation parameters, coil type and placement, dosing of stimulation and protocol settings are deliberately not given; they are matters for the treating team and the trial protocol.

A1. How MST is delivered in trials (descriptive)

Purpose: to let you explain accurately what the client will experience.
Steps (as trial documents describe): screening (history, examination, blood tests, ECG, diagnostic and rating interviews, cognitive tests); a psychiatrist reviews current medicines; fasting before each treatment; general anaesthesia with a muscle relaxant and oxygen by mask, given by an anaesthesiologist; magnetic stimulation delivered by a trained study psychiatrist to induce a seizure, monitored by EEG; recovery period afterwards; outpatients need a responsible adult to take them home; regular rating visits during the course; post-course and later follow-up assessments [source: CREST-MST consent form; Trials 2021 protocol; NYSPI consent form]. In comparison trials the client is randomised to MST or ECT and neither client nor raters know which they receive [source: CREST-MST consent form; NYSPI consent form]. If a seizure is not induced, the person wakes and options are discussed [source: NYSPI consent form]. Treatment and anaesthesia for research may be provided at no cost while screening and standard care may be billed [source: CREST-MST consent form].
Example language (illustrative): "From what the study team has described, you'd be asleep under a general anaesthetic for each treatment, a doctor would use a magnetic device to bring on a brief seizure while they monitor your brain activity, and you'd wake up in a recovery area. You'd need someone to take you home."
Watch for: misunderstandings that MST is "like TMS" done awake, or that it is "ECT without any risk" [synthesis; Psychiatric News 2021].

A2. Official safety information as trials report it

Purpose: to give balanced information and know what to monitor.
Content (attributed):
- Anaesthesia: risks include breathing difficulty after treatment, aspiration if fasting is not followed, and a very remote chance of death (the NYSPI form estimates about 1 in 10,000 for general anaesthesia) [source: CREST-MST consent form; NYSPI consent form].
- Common or expected MST effects: headache, nausea, muscle soreness, transient scalp pain; dental pain that may persist; possible hearing effects from the device's clicking noise (earplugs are provided, and the CREST-MST form warns that a loosened earplug can cause permanent hearing loss in the related TMS-EEG procedure); systemic complications of the seizure [source: CREST-MST consent form; NYSPI consent form; Psychiatric News 2021].
- Mood: possible induction of mania or hypomania; possible worsening of depression and suicidal thoughts during the study [source: NYSPI consent form; CREST-MST consent form].
- Cognition: earlier trials had not shown significant memory decline, but MST is less studied than ECT and some risk of confusion and memory loss is listed [source: CREST-MST consent form; NYSPI consent form; Psychiatric News 2021]. In CREST-MST, autobiographical memory worsening was less frequent with MST; ECT was associated with more memory impairment, jaw pain, headache and confusion, and MST with more post-treatment breathing difficulty [source: ISEN page; UTHealth news 2026]. MagVenture reports most adverse events were mild [source: MagVenture 2026; manufacturer statement].
- Other: unknown risks; risks to pregnancy (contraception required, pregnancy excluded); loss of confidentiality; a recovery period with no driving or major decisions [source: CREST-MST consent form; NYSPI consent form].
- Exclusions that signal risk: metal implants in or near the head that cannot be removed, significant neurological disorder, raised intracranial pressure, probable dementia, unstable medical illness, recent substance misuse, pregnancy [source: Trials 2021 protocol].
How adverse events are handled: asked about at every visit, reported to the site principal investigator; serious adverse events go to the NIMH Data Safety Monitoring Board, the FDA and Health Canada [source: Trials 2021 protocol].
Watch for: any of the above reported to you between visits; pass it on (see B7).

A3. Do-it-yourself and non-trial offers

Purpose: to protect clients from unsafe or misleading offers.
Content: MST requires general anaesthesia, airway management and seizure monitoring by a specialist team and, as of October 2026, is not cleared for clinical use anywhere [source: Trials 2021 protocol; MagVenture 2026]. Any offer of MST outside a registered, ethics-approved trial, or any home brain-stimulation device presented as equivalent, is a red flag [synthesis]. No source opened documents DIY seizure-induction attempts [uncertain].
Example language (illustrative): "MST is only given in research studies right now, under anaesthesia in a hospital. If you see it offered privately or as a home device, please check with me or your psychiatrist first."

B1. Recognising when to suggest a medical review

Purpose: to route clients whose depression may warrant a convulsive-therapy assessment to the prescriber.
When: severe or persistent depression despite treatment, high suicide risk, marked functional decline, or a client who has been offered ECT and is refusing or terrified because of memory concerns [synthesis; ISEN commentary frames MST as an option for those who decline ECT].
Steps: (1) Share your observations with the client. (2) Suggest, with consent, a review with the treating psychiatrist. (3) Write or call with a concise clinical summary. (4) Leave the decision about ECT, MST trials or other options to the psychiatrist and client [synthesis].
Example language (illustrative): "You've told me the memory side of ECT is what frightens you most. Would it help to ask Dr X whether there are research options, such as MST trials, that might suit you?"
Watch for: suicidal crisis needing urgent rather than routine review (see B8).

B2. Referral to trials

Purpose: to help the client and psychiatrist find and contact suitable trials.
Steps: (1) Agree with the psychiatrist who leads the referral. (2) Help the client find trial pages (registry entries on ClinicalTrials.gov; site pages such as UTHealth Houston's bipolar and treatment-resistant depression MST study, which lists ages 22–85 and was last updated in 2024, so recruitment must be confirmed) [source: UTHealth trial page]. (3) Note practicalities: travel, anaesthesia visits, escort, fasting, time off, unpaid participation in some trials [source: CREST-MST consent form; UTHealth trial page]. (4) Plan what happens if the client is ineligible [synthesis].
Example language (illustrative): "Studies have strict entry rules, so being turned down says nothing about how ill or deserving you are. Let's plan what we'd do next either way."
Watch for: pinning all hope on acceptance; financial or travel strain.

B3. Psychoeducation

Purpose: an accurate, calm understanding of what MST is and is not.
Steps: (1) Ask what the client has heard. (2) Explain the basic idea (seizure induced magnetically under anaesthesia; aimed at fewer memory effects than ECT) [source: Psychiatric News 2021]. (3) State the status plainly: investigational, available only in trials [source: MagVenture 2026; consent forms]. (4) Summarise trial results honestly, including low remission in both arms and the need for more research [source: ISEN page]. (5) Point to 015 ECT for comparison and to the trial's own information sheet. (6) Check understanding with teach-back [synthesis].
Example language (illustrative): "In the large trial, MST worked about as well as one common form of ECT and fewer people had memory problems, but it's still being tested and isn't available as routine treatment."
Watch for: confusion with TMS; overstated hopes from news or manufacturer claims (attribute such claims to their source).

B4. Informed-consent support for research participation

Purpose: to help the client make a free, informed decision; the trial team obtains and documents consent, you support it.
What research consent must cover (US FDA, 2023 final guidance): that the study is research; procedures and duration; foreseeable risks with emphasis on serious ones, including privacy risks; benefits, stating if there is none, and not counting reimbursements as a benefit; alternatives including standard care; confidentiality and that regulators may inspect records; treatment and compensation for research injury, with no wording that waives legal rights; contacts for questions, rights and injuries; voluntariness and the right to withdraw without penalty; new information shared as it emerges [source: FDA informed consent guidance 2023, via Hall Render summary]. Trial-specific: CREST-MST lists alternatives as medication alone, ECT, psychotherapy or another brain stimulation; offers no monetary compensation for research injury; and states data may be shared with NIMH, FDA, Health Canada partners and a national data archive [source: CREST-MST consent form]. Capacity is judged by a convulsive-therapy psychiatrist (CREST-MST) or by a treating clinician independent of the study (NYSPI) [source: Trials 2021 protocol; NYSPI consent form]. For legal frameworks around convulsive therapy and capacity outside research, see 015 ECT.
Steps: (1) With the client's consent, read the information sheet together or let them bring questions. (2) Help them list questions for the team: randomisation and blinding, what happens if MST does not help (the NYSPI form allows switching to ECT for non-responders), costs, follow-up, who to call out of hours [source: NYSPI consent form; synthesis]. (3) Use teach-back on risks, alternatives, and the right to withdraw. (4) Explore values and fears. (5) If you doubt the client's capacity or freedom of choice, tell the trial team and the treating psychiatrist [synthesis]. (6) Revisit consent when the team shares new information [source: FDA 2023 guidance].
Example language (illustrative): "In your own words, what would happen if you were put in the ECT group instead of MST? And what could you do if you wanted to stop?"
Watch for: severe depression slowing comprehension; hopelessness ("nothing to lose"); feeling obliged to the psychiatrist, family or you; free care as an undue incentive [synthesis; FDA 2023 guidance on coercion and undue influence].

B5. Shared decision-making, ambivalence and adherence conversations

Purpose: to help the client weigh joining, continuing or leaving a trial, without steering.
Steps: (1) Elicit reasons for and against, in the client's words. (2) Reflect both sides. (3) Name practical barriers to attendance (missed sessions can lead to removal from study treatment in CREST-MST) [source: CREST-MST consent form]. (4) Support whatever decision the client reaches; take questions about stopping or continuing to the trial team; never advise a change in treatment or medication [synthesis].
Example language (illustrative): "Part of you wants to keep going because you might be improving; part of you is worn out by the early mornings. Shall we take both of those to the study team on Thursday?"
Watch for: wishes to withdraw that are really about a fixable practical problem, or about worsening mood that the team needs to know.

B6. Supporting the client before, during and after the course

Purpose: to reduce anxiety and keep continuity.
Steps: Before: prepare for anaesthesia, fasting, transport, escort and time away from responsibilities; rehearse coping for waiting-room anxiety [source: consent forms for practical items; synthesis for coping]. During: schedule sessions away from treatment mornings where possible; shorten or simplify sessions when the client is tired or foggy; write down key points; avoid major therapeutic decisions during the course and the recovery period, consistent with the NYSPI advice to defer major decisions [source: NYSPI consent form; synthesis]. After: review what changed, rebuild routines, and process the experience of research participation, including uncertainty about the arm received [synthesis].
Example language (illustrative): "Today let's keep it light. I'll jot down the two things we agreed so you don't have to hold them in mind."
Watch for: distress about blinding; feeling like "a test subject".

B7. Monitoring and passing on side effects and mood changes

Purpose: early detection and communication to the team; the team assesses and acts.
Steps: (1) At each contact, ask briefly about headache, nausea, scalp or dental pain, hearing changes, confusion, memory gaps, and mood (including elevated mood, reduced need for sleep, racing thoughts) and suicidal thinking [source: risk lists in CREST-MST and NYSPI consent forms]. (2) Note new medicines the client mentions and remind them the trial team must be told [source: CREST-MST consent form]. (3) With consent agreed in advance, pass concerns to the trial contact the same day for anything urgent; record what you passed on and to whom [synthesis]. (4) Use routine outcome measures you already use; do not duplicate the trial's own licensed rating instruments [synthesis].
Example language (illustrative): "You mentioned you've barely slept but feel full of energy. That's something the study doctors asked to hear about. Can we call them together now?"
Watch for: signs matching the protocol's stopping reasons (marked worsening, rising suicidal intent, manic or catatonic features) [source: Trials 2021 protocol].

B8. Crisis and safety planning

Purpose: to keep the client safe through a period when worsening and suicidality are possible.
Steps: (1) Before the course, write or update a collaborative safety plan: warning signs, coping steps, people to contact, professional contacts including the trial's 24-hour line and the treating psychiatrist, emergency services, and lethal-means counselling (safe storage or removal) [synthesis; standard practice]. (2) Include the trial's own emergency guidance (CREST-MST: nearest emergency department or emergency number, and a crisis line) [source: CREST-MST consent form]. (3) Agree with the client in advance what you will share with the team if risk rises. (4) Review the plan at each stage, especially at the end of the course and after hand-back, when trial contact reduces [synthesis].
Example language (illustrative): "If things get worse between treatments, who will you call first, and what's the study team's out-of-hours number? Let's put it on the plan."
Watch for: hopelessness if improvement is slow; the trial team may consider hospital admission or withdrawal from the study if safety concerns arise [source: CREST-MST consent form].

B9. Integrating psychotherapy before, during and after

Purpose: to make psychological work and the convulsive course complementary.
Steps: (1) Ask the trial team whether starting new psychotherapy or changing its frequency is acceptable during the course. The protocol paper and the full protocol (v15.0) set rules for medicines only and say nothing on psychotherapy, so confirm local practice [source: Trials 2021 protocol; CREST-MST protocol v15.0; uncertain whether sites apply an unwritten rule]. (2) Before: behavioural activation at a manageable level, sleep and routine, values work about why the client is seeking treatment [synthesis]. (3) During: supportive, low-demand sessions; keep structure light. (4) After: relapse-prevention work (early warning signs, activity scheduling, problem-solving), addressing residual symptoms, and rebuilding work and relationships in the first weeks, while respecting the recovery-period advice [source: NYSPI consent form for recovery advice; synthesis for the rest]. (5) If cognitive complaints persist, help the client describe them precisely for the team's follow-up cognitive testing [source: follow-up testing per consent forms; synthesis].
Example language (illustrative): "Now that the treatments have finished, let's map what a good week looks like and the first signs that would tell us depression is creeping back."
Watch for: expecting the treatment alone to resolve long-standing difficulties.

B10. Support after the trial ends

Purpose: continuity when trial contact stops.
Steps: (1) Confirm who holds continuation care after the referral back to the treating psychiatrist [source: CREST-MST consent form]. (2) Help the client plan for no ongoing access to MST outside research [source: MagVenture 2026]. (3) Support decisions about receiving their arm allocation or results if the trial offers this, and about sharing data (CREST-MST allows opting out of future data sharing) [source: CREST-MST consent form]. (4) Process disappointment if the treatment did not help, and support the next plan made with the psychiatrist [synthesis].
Example language (illustrative): "The study ending can feel like a cliff edge. Let's check who you'll see and when, so there's no gap."
Watch for: relapse in the months after the course; grief or anger about non-response.

5. Handling problems

Trial documents cover safety-related stopping and withdrawal; almost all of the psychotherapist guidance below is [synthesis].

Client is not eligible or is turned down. Normalise strict criteria (for example exclusions for psychotic depression, substance misuse, neurological illness, head implants, pregnancy) [source: Trials 2021 protocol]; return to the psychiatrist for other options, including standard ECT (see 015 ECT) [synthesis].
Client wants MST but refuses any chance of ECT. In comparison trials randomisation to ECT is possible [source: CREST-MST and NYSPI consent forms]. Help the client face this honestly before consenting; joining while privately planning to drop out if allocated ECT should be discussed openly with the team [synthesis].
Overvaluation and false hope. Gently correct claims such as "no memory side effects"; such phrasing came from an investigator quote in a manufacturer release, while trial documents list possible confusion and memory loss [source: MagVenture 2026; NYSPI consent form]. Keep hope realistic: remission was modest in both arms [source: ISEN page].
Overwhelm from screening and assessment load. Long cognitive and rating sessions can tire severely depressed clients [source: CREST-MST consent form on test length]. Help them pace the day and tell the team if testing is too much [synthesis].
Non-adherence: missed treatments or fasting lapses. Missing sessions can lead to removal from study treatment; not fasting raises aspiration risk [source: CREST-MST consent form; NYSPI consent form]. Problem-solve transport, escort and alarms; tell the team early rather than letting the client quietly drop out [synthesis].
Worsening mood or rising suicidality during the course. Increase contact, update the safety plan, and contact the trial team the same day; emergency services if imminent [source: CREST-MST consent form; synthesis]. The team may stop treatment, admit, or consult the referring psychiatrist [source: CREST-MST consent form; Trials 2021 protocol].
Elevated mood or mixed features. Possible induction of mania is listed [source: NYSPI consent form]. Report promptly; do not interpret it as simple recovery [synthesis].
Memory or concentration complaints. Validate, document specifics, report to the team, and use memory aids in sessions; avoid reassuring that the problem is definitely temporary or definitely due to the treatment [synthesis].
Hearing changes, persistent dental or jaw pain. Listed risks; pass on promptly [source: NYSPI consent form; CREST-MST consent form].
Distress about blinding ("I need to know which one I had"). Explain why blinding protects the study; ask the team what will be disclosed and when [synthesis].
Wish to withdraw. Affirm the right to leave without loss of care [source: consent forms; FDA 2023 guidance]; explore reasons; help the client tell the team; the team may request safety checks after withdrawal [source: CREST-MST consent form].
Rupture with the therapist ("you sent me to be experimented on"). Acknowledge, take responsibility for your part in the referral, re-emphasise the client's choice, and repair before moving on [synthesis].
Family pressure for or against participation. Meet with family if the client wishes; give the same balanced information; keep the decision with the client [synthesis].
Confidentiality worries. Explain the trial's data-sharing statements (regulators, sponsor, data archive) and the opt-out where offered [source: CREST-MST consent form]. Agree what you and the trial team will share with each other, in writing [synthesis].
Offers of MST outside research or online. Treat as a red flag given the absence of any clearance as of October 2026 [source: MagVenture 2026; synthesis].
Relapse after the course ends. Activate the relapse-prevention plan and arrange prompt review with the psychiatrist [synthesis].
Your own uncertainty or enthusiasm. Seek supervision; keep to what trial documents say; status may change, so re-check regulatory information before each referral [synthesis].

Sources

Sources: