Electroconvulsive Therapy (ECT) and repetitive Transcranial Magnetic Stimulation (rTMS/TMS) are both alternative therapies typically used to treat depression in those who have been resistant to both Psychotherapy and Medication. Although both ECT and TMS have been found to be effective, they vary in a number of ways.
ECT is a psychiatric treatment that involves emitting an electrical current into the brain with the purpose of causing a seizure. During this process, individuals are under general anesthesia. Along with general anesthesia, each treatment involves patients receiving a muscle relaxant (generally through an IV) and electrodes that are attached to precise locations on the scalp. Two of these electrodes monitor brain activity, while two administer the electrical current. When the current is delivered, patients will be in a seizure for approximately one minute, waking up 5-10 minutes after the procedure is completed. Common side effects reported by patients immediately following ECT include:
- Jaw pain/ muscle aches
- Memory loss
- Increase in heart rate/blood pressure
Patients have also reported long term negative effects after having done ECT, primarily with moderate to severe memory loss. This is because the ECT electrodes are placed bilaterally over the temporal lobes, which is where the molecular signatures for memories (especially autobiographical memories) tend to be stored. A strong electrical current can thus destroy these memory traces. A patient typically receives ECT 2-3 times a week, or once every 2-5 days, for a total of 6 to 12 sessions depending on the severity of symptoms and response to treatment.
Unlike ECT, patients who do TMS are awake for the duration of their session, and compare the magnetic pulse being administered to a light tapping sensation on the scalp. TMS uses a magnetic generator, or “coil”, that delivers an electromagnetic current to excite/inhibit neurons in the region of the brain responsible for depression and emotional regulation. Immediately following a session, patients report only mild headaches 25% of the time. Side effects during TMS treatment include minor facial twitching (usually the eyebrow) and minor scalp discomfort. The side effects reported improve shortly after a session, and decrease as the patient continues with his or her TMS program.
TMS sessions are typically 30-40 minutes long, and are carried out five days a week for four to six weeks. Unlike ECT, there are no long term side effects (such as memory loss) reported after doing TMS.
A study which compared ECT and TMS for Treatment Resistant Depression (TRD) found that individuals who underwent ECT reported a higher percentage of side effects. Patients much preferred TMS treatment to ECT. While both ECT and TMS are clinically accepted treatment approaches for depression, it is important that individuals research the effectiveness and associated side effects for these modalities. If you’d like to schedule a consultation to learn more about the differences between TMS and ECT for you or your loved one, please contact us today.
- Magnezi R, Aminov E, Shmuel D, et al. Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness. Patient Prefer Adherence. 2016;10:1481-1487.
- American Psychiatric Association Committee on Electroconvulsive Therapy. Treatment procedures. In: The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001:133.
- George MS, Wassermann EM, Post RM: Transcranial magnetic stimulation: a neuropsychiatric tool for the 21st century. J Neuropsychiatry Clin Neurosci 1996; 8:373–382Crossref, Medline, Google Scho
- George MS , Lisanby SH , Avery D , McDonald WM , Durkalski V , Pavlicova M , Anderson B , Nahas Z , Bulow P , Zarkowski P , Holtz-heimer PE , Schwartz T , Sackeim HA: Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry 2010; 67:507–516Crossref, Medline, Google Scholar
- Pascal Sienaert, MD, PhD : What We Have Learned about Electroconvulsive Therapy and its Relevance for the Practising Psychiatrist. The Canadian Journal of Psychiatry
- Vol 56, Issue 1, pp. 5 – 12; First Published January 1, 2011