Polster 2015.

Study characteristics
Methods	Study design: open‐label, parallel, randomised Total duration of study: 5 to 6 weeks Number of study centres and locations: 1, University Hospital, Bonn, Germany. Study setting: no information Withdrawals: no information Dates of study: June 2009 to December 2012
Participants	Number: 10 for MST; 10 for ECT; 10 healthy controls Mean age (SD), age range: 43.7 (11) for MST; 54.7 (13) for ECT; no information on range Gender: 3 females in MST; 6 females in ECT; 6 females in healthy controls Course of disease:current episode, years (SD): 4.1 (4) for MST; 3.1 (3) for ECT Severity of condition HAMD‐28 (SD) 25.3 (7) for MST; 23.2 (8) for ECT BDI (SD) 27.7 (8) for MST; 24.3 (11) for ECT Diagnostic criteria Affective disorder with current major depressive episode diagnosed according to DSM‐IV TRD defined as stage 2 of resistance according to Thase and Rush for patients who are unresponsive to 2 different antidepressant treatments of adequate length and dosage during a current episode of depression Inclusion criteria 18 to 69 years old Clinical indication for MST/ECT Minimum score of 20 on HAMD‐28 Absence of former ECT treatments for patients with MST Not pregnant Exclusion criteria Diagnosis of cognitive disorder or signs of dementia, delirium, amnesia, or non‐affective psychotic disorders Alcohol or substance dependence within previous 12 months or substance‐related addiction within past 6 months (except nicotine) Anaesthesiologically relevant cardiac disease Any head injury relevant to MST/ECT Other disease of the central nervous system Implanted medical device and magnetic material in the head or body Co‐morbid conditions: no information
Interventions	MST (coil placement, frequency, dose, number of sessions) Centre of the twin coil was placed at the vertex 100 Hz Ascending titration was done with 100, 200, 300, etc,, pulses in train upon the first trial. Minimum number of pulses required to activate a tonic‐clonic seizure defined the individual seizure threshold. For subsequent trials, seizures were induced by stimulation seizure threshold 10 to 12 sessions ECT (electrode placement, pulse width, dose, number of sessions) Right unilateral 0.5 ms Ascending titration determined seizure threshold during first treatment. Following stimulations were performed at 5‐fold over seizure threshold 10 to 12 sessions Concomitant medications: antidepressant medication was kept stable 1 month before and during the entire course of treatment Concomitant psychosocial interventions: no information Excluded medications: no information
Outcomes	Primary and secondary outcomes specified and collected Specified HAMD‐28 (primary) MADRS Collected Learning model based on reciting of memorised word lists Time points reported HAMD‐28 and BDI at baseline (2 weeks before treatment) Memorised words 2 hours before and after 2 treatment‐free days and 2 treatment days (2 weeks within start of treatments) Outcome data reported in a usable way: yes; extracted from figures
Notes	Funded in part by MagVenture A/S
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Described as randomised but no information given about how the sequence was generated
Allocation concealment (selection bias)	Unclear risk	No information
Blinding of participants and personnel (performance bias) All outcomes	High risk	Described as open‐label
Blinding of outcome assessment (detection bias) All outcomes	High risk	Described as open‐label
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No information
Selective reporting (reporting bias)	High risk	Protocol specified HAMD and MADRS as outcomes. However, study reported memory performance
Other bias	High risk	The study is funded in part by a manufacturer of MST devices

BDI: Beck Depression Inventory.
BP: bipolar disorder.
BPI: bipolar disorder I.
BPII: bipolar disorder II.
DSM‐IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.
ECT: electroconvulsive therapy.
EEG: electroencephalogram.
HAMA: Hamilton Anxiety Rating Scale.
HAMD: Hamilton Rating Scale for Depression.
MADRS: Montgomery‐Äsberg Depression Rating Scale.
MDD: major depressive disorder.
MST: magnetic seizure therapy.
SCL‐90: Symptom Checklist‐90.
SD: standard deviation.
TRD: treatment‐resistant depression.