January 20, 2025 - neurocare group
When it comes to treating severe or treatment-resistant depression, two of the most powerful therapeutic options available are Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT). Both are brain neurostimulation techniques, but they differ in several significant ways. This article will summarise how these techniques work and highlight important criteria which are useful to determine when each therapy might be useful.
TMS in depression treatment
With a long history in depression treatment, TMS is widely used and proven to be effective. By targeting brain regions associated with mood and emotional processing with electrical stimulation, TMS modulates activity in neural networks involved in depression. The procedure involves placing a specialized coil against the scalp, which then sends short, repetitive magnetic pulses to targeted, shallow regions of the brain. These magnetic pulses generate small electrical currents, increasing the firing chance of local neurons, and alleviate symptoms of depression.
TMS is a non-invasive treatment, meaning it does not require surgery or implantation of electrodes, making it a more accessible option for many patients. Typically, TMS is administered over a course of several weeks, with each session lasting approximately 20 to 40 minutes. During these sessions, patients remain awake and alert, and the procedure is generally well-tolerated, allowing them to resume their daily activities immediately afterward. This structured and repetitive approach is designed to achieve cumulative therapeutic effects, offering a promising alternative for those who have not found relief through antidepressant medications.
ECT in depression treatment
In ECT treatment, a controlled seizure is induced in the brain by passing a brief but stronger electrical current through electrodes placed on the scalp. This current stimulates the entire brain, leading to widespread neural activity that can result in significant improvements in mood disorders. ECT is typically administered in a hospital setting, under general anaesthesia. Muscle relaxants are also given to minimize physical movements which might be triggered by the induced seizure. The treatment is usually recommended only after most other options have been exhausted, such as when patients have not responded to multiple antidepressant medications or other forms of therapy.
ECT is disruptive and requires anaesthesia, but it can offer rapid and substantial relief for individuals suffering from severe, treatment-resistant depression, bipolar disorder, schizophrenia, and catatonia. The procedure is generally performed two to three times a week for a total of six to twelve sessions, depending on the patient's response and specific needs. Post-treatment, patients are closely monitored for any side effects, and follow-up sessions may be scheduled to maintain the therapeutic benefits.
Who does TMS benefit?
One reason for the popularity of TMS lies in its non-invasive nature, which allows patients to undergo treatment comfortably without anaesthesia or inpatient care. The magnetic pulses used in TMS focus on areas of the brain associated with mood regulation, allowing precision targeting of the brain regions which are causing the symptoms. This precision not only makes TMS a trustworthy option for those who have yet to find success with antidepressants but also minimizes the risk of side effects, which can be important for patients seeking relief without significant disruption to their daily lives.
The program design of TMS therapy—typically lasting between 20 to 40 minutes—ensures that patients can quickly resume their normal activities post-treatment. This level of convenience is further beneficial for individuals who engage in therapy alongside other commitments and are looking for a minimally disruptive option. As research continues to expand, TMS is showing promise in addressing a broader range of mental health challenges, from anxiety and PTSD to cognitive impairments related to long COVID.
Side Effects and Patient Experience of TMS
As a well-tolerated treatment for most patients, TMS is a favorable option for those seeking non-invasive mental health treatments. The most common side effects associated with TMS are mild headaches or scalp discomfort at the site where the treatment is administered. These side effects are typically minor and temporary, often subsiding shortly after the session concludes and becoming milder after each session. TMS does not necessitate any form of anesthesia, allowing patients to remain fully awake and alert during the treatment. This allows practitioners to combine TMS with talk-based psychotherapy for a dual-therapy strategy, which can be more effective than TMS alone.
Who does ECT benefit?
Typically applied in inpatient settings, ECT is widely recognized for its effectiveness in treating severe and treatment-resistant depression when other treatments have failed. It is also used for severe cases of bipolar disorder, schizophrenia, and catatonia. ECT is often recommended when a rapid response is necessary, such as in cases of severe suicidal ideation. For more detailed information, you can refer to the Mayo Clinic page.
Side Effects and Patient Experience of ECT
ECT is associated with a wider range of side effects than TMS. Among the most notable side effects are memory loss and confusion, which can vary in both duration and severity between patients. Some patients may experience short-term memory issues that resolve relatively quickly, while others might suffer from more persistent effects that can last longer. Additionally, because ECT involves the use of general anesthesia, patients require a longer recovery time than with TMS. The need for general anesthesia not only extends the recovery period but also adds an element of risk and complexity to the procedure. Additionally, the frequency of ECT treatments and the severity of the conditions it addresses usually require it to be administered to hospital inpatients. This inpatient requirement means that ECT is generally reserved for more severe cases where other treatments have not been effective, and it is less accessible to those who might benefit from it outside the hospital.
Which Neurostimulation treatment is appropriate?
TMS and ECT are both powerful tools in the fight against severe mental illness. Consulting a healthcare provider can help determine the most appropriate course of action, ensuring that the treatment plan is customized to the individual's unique needs and circumstances.
Evaluating the efficacy of TMS and ECT means considering the severity of a person's disorder, their medical history, and their tolerance for any side effects that might occur. Practitioners may prescribe ECT treatment in severe cases of treatment-resistant depression, often when all other treatment options haven't been successful, whereas TMS might be more appropriate for patients who have not responded to antidepressants but do not experience sufficiently severe symptoms for hospital care. However, it is important to note that the cases for TMS and ECT change on a case-by-case basis according to individual needs.
neurocare provides TMS treatment in clinics globally. Our TMS protocols are evidence-based and standardised internationally according to recent research. For more information, make an enquiry with your local clinic or take a look at our info pages available online.
