Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) are both treatments for depression and other mental health disorders, but they differ greatly. We explain the difference between ECT and TMS so you can better understand these two treatment options.
Neuromodulation
All forms of neuromodulation use electrical or magnetic pulses to influence activity in specific areas of the brain. The most well-known method is electroconvulsive therapy (ECT), in which direct electrical current is delivered through electrodes on the head to induce a brief, controlled epileptic seizure. TMS (transcranial magnetic stimulation), on the other hand, works by generating an electromagnetic field outside the head. This field induces small electrical currents in the cerebral cortex without direct electrical current running through the head as in ECT. This fundamental difference makes TMS a more subtle and generally better-tolerated treatment that does not induce seizures.
Electroconvulsive Therapy (ECT)
ECT was first introduced in the 1930s by Italian psychiatrists Ugo Cerletti and Lucio Bini. They discovered that delivering electric shocks to the brains of patients with severe psychiatric conditions, such as schizophrenia, led to significant improvements in their symptoms. Today, ECT is primarily used for severe depression, bipolar disorders, and certain forms of schizophrenia, especially when other treatments have been ineffective.
What is ECT?
ECT is a medical treatment in which a brief electrical impulse induces a controlled epileptic seizure. A seizure is an electrical discharge in the brain that causes muscle contractions lasting a few seconds. Nowadays, ECT is performed under anesthesia with muscle relaxants to ensure the patient’s comfort and safety. During the procedure, heart and brain activity are continuously monitored. For more information, visit the website of the Leiden University Medical Center.
How does ECT work?
In depression, the balance of certain brain chemicals, such as serotonin, can be disrupted. These chemicals are crucial for communication between brain cells, especially in regions involved in mood and anxiety. A brief electrical stimulus causes a generalized discharge (seizure) of brain cells. Repeated seizures can help restore chemical balance, promote the formation of new neural pathways, and, over time, alleviate symptoms. ECT is usually administered in a series of sessions, typically two to three times a week over several weeks.
Indications for ECT
- Severe depression, especially when there is a risk of suicide.
- Bipolar disorder with severe depressive or manic episodes.
- Schizophrenia, particularly with catatonia or other severe symptoms.
- Treatment-resistant depression when other therapies have failed.
Side Effects of ECT
- Short-term memory problems.
- Headaches and muscle soreness.
- Confusion after treatment, usually temporary.
- General anesthesia carries standard medical risks.
Transcranial Magnetic Stimulation (TMS)
TMS is a relatively new treatment developed around 1990 as a non-invasive alternative to ECT. This treatment uses magnetic fields to stimulate specific brain regions without anesthesia or inducing seizures. Today, it is widely used as a treatment for moderate to severe depression, especially in patients who do not respond well to medication or other therapies. Its non-invasive nature makes it an attractive option for many.
What is Transcranial Magnetic Stimulation?
In TMS, magnetic pulses are used to stimulate specific brain areas involved in depressive symptoms or other conditions. This targeted stimulation helps normalize activity in these regions, reducing symptoms such as low mood, anxiety, or obsessive thoughts. A unique advantage of TMS is its precision: the treatment focuses only on the brain areas that are out of balance, without affecting the rest of the brain. This makes TMS accurate, effective, and associated with minimal side effects compared to treatments that affect the entire brain. You can find more information about the treatment, its benefits, and how it works on our website.
How does it work?
During an TMS session, a coil is placed on the scalp, usually over the prefrontal cortex, an area that plays a key role in mood regulation. This coil generates brief magnetic pulses that induce small “electrical currents” in the underlying brain regions. These pulses can either increase or normalize activity, depending on the stimulation protocol used. The treatment specifically targets areas of the brain that are dysregulated in conditions such as depression or OCD.
rTMS sessions are typically administered daily or several times a week over a period of several weeks. Each session usually lasts between 30 and 60 minutes. The treatment course can be tailored to the severity of the symptoms, the protocol, and the patient’s response.
Indications for TMS
- Depression, especially when other treatments have failed.
- Anxiety disorders.
- Obsessive-compulsive disorder (OCD).
Side Effects of TMS
- Mild headache or discomfort at the stimulation site.
- Facial muscle twitches or tingling during treatment.
- No memory loss or confusion, unlike ECT.
The biggest difference between ECT and TMS?
The most important difference between ECT and TMS for those seeking treatment for depression or OCD is that ECT is much more invasive, requiring anesthesia and inducing a controlled seizure. TMS is non-invasive, does not require anesthesia, and does not cause seizures. ECT carries a higher risk of potential side effects such as memory problems and confusion, whereas TMS generally causes only mild and temporary side effects like headaches.
TMS delivers targeted pulses to specific brain areas rather than affecting the entire brain, as ECT does. This targeted approach significantly reduces the risk of unwanted side effects. While ECT is more broadly applicable and suited for the most severe cases, TMS is an ideal option for treatment-resistant depression and OCD in patients who have not responded to medication and prefer a less invasive, medication-free treatment.
Do you know the difference?
Both ECT and TMS are valuable treatments for depression and other mental health conditions, each with their own advantages and disadvantages. The choice between these treatments depends on the severity of symptoms, previous treatments, and your personal preferences. It is important to discuss your options with a professional to determine the most appropriate treatment. Are you curious about what rTMS International can do for you? Sign up for rTMS or contact us if you have any questions.