Comparing ECT and TMS - Active Path Mental Health in OR and WA

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The road to recovery for depression patients is seldom clear or straightforward. The first line of defense, typically a combination of antidepressants and psychotherapy, may prove ineffective or too fraught with side effects to be helpful. Fortunately, alternatives are available for those dealing with more extreme or treatment-resistant varieties of this disorder. In cases of severe or treatment-resistant depression, oftentimes ECT or TMS will be necessary.  There is a lot of confusion surrounding the differences between ECT and TMS, and what situations are likely to be appropriate for ECT vs TMS. The milder side effects of TMS vs ECT make TMS a much more viable option for many. Many treatment-resistant depression patients find promise in transcranial magnetic stimulation.

When one compares TMS vs ECT, two major differences tend to stand out. TMS alleviates MDD symptoms by sending electromagnetic pulses into the prefrontal cortex, while ECT “resets” neurological pathways through electroshock seizures. Although effective in many dire scenarios, the disruptiveness of ECT vs TMS treatment is much more severe. For this reason, ECT sessions require anesthesia and a longer healing process. TMS is a non-invasive option for MDD sufferers seeking painless treatment with few, mild and easily tolerated side effects.


ECT is the abbreviation for Electroconvulsive therapy.  This procedure has been referred to by its abbreviation among the Psychiatric community for many years.  ECT is well known by both doctors and patients by it’s abbreviation as well as the full name of electroconvulsive therapy. 


Transcranial Magnetic Stimulation or TMS is a growing therapy that is well known by professionals and the public is becoming much more educated on this term as well.  The abbreviation, TMS, is an easy way to refer to the therapy to people who have an understanding of it. 


Doctors prescribe ECT and TMS under very different circumstances. Transcranial magnetic stimulation uses electromagnetic pulses similar to the strength of an MRI machine. By specifically targeting the prefrontal cortex—where MDD symptoms often originate—these pulses are able to reactivate the neurotransmitters believed to be responsible for depressive symptoms

TMS patients undergo sessions over the course of four to six weeks. A metal coil is painlessly attached to the front region of the head, and is measured and calibrated in the first session for both proper positioning and level of intensity. When the machine reaches the correct intensity, known as the motor threshold, the patient experiences a slight twitching in the thumb. Once levels and positioning are determined, the device emits a low electromagnetic pulse. Other than a tapping sound and sensation on the scalp, patients generally feel nothing are encouraged to relax during the session. After a TMS session, patients can drive themselves home and resume their normal daily schedules.In recent studies, up to 70 percent of patients showed a positive response in just a few weeks.

Reserved for severe cases of psychosis, catatonia, or bipolar disorder, ECT, on the other hand, is best for those unable to wait for immediate alleviation of their life-threatening symptoms. ECT requires the anesthetization of patients before triggering a seizure with the use of a low electrical current. Due to the nature of the process, patients must undergo an extensive medical screening beforehand, to ensure they are healthy enough to handle both the treatment and potential side effects.

Precautions include the analysis of each patient’s complete medical history, as well as a physical and psychiatric exam. Medication is also strictly monitored during the process to minimize the risk of any complications, such as hypertension or other cardiovascular issues.

Before the appointment, patients must follow the standard procedure before undergoing anesthesia, including restricting the diet up to the evening before. After administering the muscle relaxants and anesthesia, doctors place two small electrodes on the head, through which a low electrical current is sent to induce a 60-second seizure. After an ECT treatment, a period of confusion and slight memory loss can follow. It’s important (and required) for ECT patients to travel home with a responsible caretaker for monitored care.

Doctors only prescribe ECT therapy when absolutely necessary, as its side effects and risks can be problematic if any other health risks are present. 

TMS provides an alternative to both antidepressants and ECT, for patients seeking non-invasive relief from MDD. With a far lower risk of side effects (and milder side effects in general), TMS may be the answer when other treatments fail to remedy major depressive disorder. Patients and their families should discuss the pros and cons of choosing ECT or TMS and weigh the options carefully.


Some of the clearest differences between ECT vs TMS lie in their side effects, both immediately following each procedure and in the long term. In both cases, side effects are rare and can usually be prevented with medical assessment before the procedure. Because ECT is often reserved for more extreme cases and is complicated by the use of muscle relaxants and anesthesia, side effects can be more prominent in ECT than in other treatments. In the use of TMS, however, side effects tend to be short-lived and far less severe.

The most immediateECT side effects occur just after each session. Patients may wake from their anesthesia feeling confused, unable to pinpoint where they are or how to manage their surroundings. For this reason, it’s important that patients receive assistance in coming and going from appointments. This confusion only tends to last a few hours, but in some cases—such as in older patients—the period of confusion can last for several days.

Immediate effects also include slight muscle aches and discomfort, even with the use of muscle relaxants during the procedure. This can extend to nausea, jaw pain, and headache. Over-the-counter medication is often strong enough for the level of pain reported.

Memory loss, though rare, may occur immediately after the ECT session and in the days that follow. Known as retrograde amnesia, some patients report losing memories before or around the weeks of the sessions themselves. Many describe losing memories of getting to the doctor’s office or the hours that follow.

More severe complications from ECT are rare. A medical team will complete an extensive assessment before going forward with the treatment, to prevent occurrences such asheart complications and spikes in blood pressure. Any pre-existing heart problems before the ECT session can exacerbate these possibilities.Extreme complications such as death can happen, but are incredibly rare in the modern administration of ECT treatment.

While ECT treatment has greatly improved over the years, TMS vs ECT patients have a much lower occurrence of side effects and discomfort during and immediately following treatment.During clinical trials, no TMS patients experienced the most common symptoms associated with antidepressants—such as fatigue, sexual dysfunction, weight gain or digestive complications.

During the session itself, patients often report sensitivity to the tapping of the machine. Doctors can and do offer protection for the ears, in the form of earplugs, during each treatment and ibuprofen for discomfort just after the TMS session. The most frequent side effects reported are headaches and scalp discomfort, primarily only following the first week of treatment. As sessions and weeks go on, side effects lessen and become shorter-lived.

Before undergoing either ECT or TMS, patients will discuss any medications or medical history with their doctors. In TMS vs ECT, however, interactions and complications are far more rare. Combining TMS withcertain medications, such as Wellbutrin, may cause problems such as tinnitus, or ringing in the ears.

Some circumstances can also increase the risk of seizure in TMS patients, although this risk is extremely small and has not been seen in larger clinical trials. As with ECT, patients undergoing TMS who have a history or genetic predisposition to seizures or heart problems will need to work more closely with their medical team to ensure they can undergo the treatment safely and successfully.

In contrast with antidepressants, only five percent of TMS patients decided to discontinue their sessions due to discomfort or side effects. Paired with its high success rate, this makes TMS ideal for patients who have already found at least two varieties of antidepressant to be unsuccessful or unbearable due to side effects. TMS is a non-invasive, fast-acting method of treating complicated MDD with persistent symptoms.

ECT and TMS may appear similar: both treatments involve targeting the brain through what may appear to be similar techniques (placing equipment on the head) and both are used when more traditional treatments fail to alleviate severe symptoms. Yet in their purpose, administration, and patient experience, the differences between ECT vs TMS are distinct. 

ECT is recommended in extreme cases of psychosis and catatonia, meant to quickly address life-threatening symptoms that could further intensify without immediate intervention. Side effects come from both the process of inducing a seizure and the anesthesia and muscle relaxants necessary for a safe process.

TMS is best for major depressive disorder sufferers who have found no relief from the first and second lines of treatment prescribed for their symptoms. TMS sessions are painless and non-disruptive to daily life, with side effects that are mild and brief. TMS helps those struggling with MDD to take on their depression and move on with their lives, without having to focus on the additional side effects and recovery hurdles of the treatment itself.


What is TMS?

TMS stands for transcranial magnetic stimulation. it’s a treatment that uses magnets to stimulate the prefrontal cortex to promote brain cell activity to decrease depressive symptoms. it’s a drug free therapy with contraindications so limited that patients require no post-treatment monitoring and are able to drive home straight away.

What are the most common side effects of TMS?

The most common side effects of TMS are scalp discomfort and headache.

What is ECT?

ECT stands for electroconvulsive therapy. The treatment induces a seizure and muscle relaxants and anesthesia are used. Patients experience confusion and short term memory loss and need to be monitored post treatment.

What are the most common side effects of ECT?

The most common side effects of ECT are confusion, short term memory loss and muscle aches.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Path website is solely at your own risk.

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