ECT vs. TMS: Two Approaches to Treating Depression

ECT vs. TMS: Two Approaches to Treating Depression

I first heard about TMS on the internet. I needed something new and wanted to avoid electroconvulsive therapy (ECT). 

Sheryl, TMS patient

One of the most common questions we hear from patients considering TMS?

“How does it compare to ECT?”

ECT (Electroconvulsive Therapy) and TMS (Transcranial Magnetic Stimulation) are both treatments used in psychiatry, particularly for the treatment of depression and other mood disorders.

However, they operate on different principles and have distinct effects, all of which are important to be aware of before beginning treatment.

Today we’re highlighting the key differences between ECT and TMS:

1. Mechanism of action

ECT involves passing electrical currents through the brain to induce controlled seizures. The exact mechanism of action is not fully understood, but it’s believed to involve alterations in neurotransmitter systems (the body’s “chemical messengers”) and neuroplasticity (the nervous system’s ability to reorganize in response to outside stimuli).

TMS, meanwhile, uses electromagnetic coils to generate focused magnetic fields that pass through the skull to stimulate targeted regions of the brain. It changes how the brain cells work in specific areas that affect mood.

2. Invasiveness

ECT is considered more invasive than TMS as it requires general anesthesia and muscle relaxants to prevent injury during the induced seizure.

TMS is considered non-invasive, as it involves placing a magnetic coil near the scalp without the need for anesthesia or muscle relaxants. It is typically administered in an outpatient setting, with patients able to resume daily activities immediately following a treatment session.

3. Indications 

ECT is typically used to address severe depression that hasn’t responded to other treatments, as well as other mental health conditions such as bipolar disorder with psychotic features and catatonia.

TMS is most often recommended for treating depression, especially for individuals who have not responded to antidepressant medications. It also has demonstrated effectiveness in treating PTSD, OCD, and other anxiety disorders.

4. Side effects

ECT can cause short-term side effects such as confusion, memory loss, headaches, muscle aches, and nausea. Memory loss is a notable concern, especially with retrograde amnesia (loss of memory of events before treatment) and anterograde amnesia (difficulty forming new memories).

TMS is generally considered to have significantly fewer side effects compared to ECT. Common side effects may include scalp discomfort or mild headache during or after the procedure. Rare cases of seizures induced by TMS have been documented (though the risk of this is very low).

5. Accessibility

ECT is generally more expensive due to the need for anesthesia, specialized equipment, and hospitalization. Accessibility may be further limited due to the requirement of specialized facilities.

TMS can be costly as well, but typically less expensive than ECT. (At Sonder, our team will work with your insurance to make your treatment as accessible as possible.) As more clinics begin to offer TMS services, its accessibility should only continue to improve. 

Overall, while both ECT and TMS are used for treating depression, they differ in terms of their mechanism of action, invasiveness, side effects, and accessibility. The choice between the two treatments depends on various factors including the severity of the condition, individual patient characteristics, and treatment preferences. If you’re considering either ECT or TMS, a good first step is to consult with a professional to help determine which treatment is right for you.


Interested in learning more about TMS?  


Enjoy this post? Check out these other posts about TMS:

TMS Patient Experience: Whytnee
TMS Patient Experience: Amy
TMS: The Promising Depression Treatment You’ve Never Heard Of
Preparing for Your TMS Evaluation
5 Reasons to Choose Sonder Psychiatry
Meet the Providers: Erin Fritz
Meet the Providers: Lisa Lemke
Meet the Providers: Daniele (Dani) Hagberg