TMS VS ECT (SHOCK THERAPY)

Transcranial Magnetic Stimulation (TMS) Vs Electroconvulsive Therapy (ECT)

Both TMS and ECT are indicated for Treatment Resistant depression. Both TMS and ECT aim at stimulating the brain to induce therapeutic neuromodulation in the brain circuits. TMS uses magnetic field pulses, while ECT does it by delivering electrical “shock” directly. As magnetic stimulation can go through the skull without intentionally causing a seizure, TMS has none of the side effects associated with ECT. In this article, we will discuss the similarity and differences. You can refer to the comparison table for easy side by side review.

What's the success rate of TMS? Click here to learn more.

Definition

TMS stands for Transcranial Magnetic Stimulation. Other terminologies and subtypes used for TMS are repetitive transcranial magnetic stimulation, intermittent theta burst stimulation, deep transcranial magnetic stimulation, and accelerated transcranial magnetic stimulation.

ECT stands for Electro-Convulsive Therapy. Other terminologies used for ECT are electrical shock therapy or shock therapy.

Mechanism Of Action

TMS, as per Faraday’s law, electrical fields can induce electrical current and vice versa. In TMS, an electrical current runs in pulses into a coil of wires. This will generate a targeted magnetic field. When pointed directly at a specific area of the brain, this magnetic field will induce small electrical activation of the target brain cells, which leads to the desired effect. Typically, there are no side effects of this activation. A seizure is indeed very rare to happen (1/30,000) and is considered an undesirable side effect.

Click here to learn more about how TMS works

ECT uses electricity directly and diffusely. A powerful electrical current is run through the skull diffusely through the brain leading to an electrical activation. This leads to the desired effects and sometimes undesired ones (memory loss). Because electrical shock is painful, patients need to be under full sedation during the treatment. The electrical shock produces a therapeutic seizure for about 1-3 minutes.

Indication

TMS is currently FDA approved for the indications of depression, OCD, and smoking cessation. It is commonly used for anxiety, PTSD, fibromyalgia, insomnia, and other mental and neurological disorders.

Click here to learn more about conditions treated with TMS

ECT is indicated for resistant depression, resistant psychosis, bipolar, catatonia, and neuroleptic malignant syndrome.

Location

TMS is done in an out-patient setting. This means that TMS is done in a doctor’s office. TMS doesn’t require anesthesia, and patients are fully awake during the treatment. Patients can drive themselves before and after the treatment.

ECT is done in a hospital. This is because it requires general anesthesia. Patients will need to be monitored for a couple of hours after they wake up from sedation. A family member needs to be around to drive them back home.

Specialty of Doctors Involved

TMS is ordered and supervised by a psychiatrist. The treatments are delivered by a TMS technician trained in utilizing the TMS machine.

  Number of Treatments

TMS is done daily, 5 days a week for 6 weeks for 30 sessions, then taper off 6 sessions over 3 weeks. The total number of treatments in 36 sessions.

ECT is done 2-3 times a week, a few weeks, for a total of about 12 sessions. Taper off, and maintenance ECT is usually recommended.

Risks

TMS can result in a seizure, but this side effect is scarce (1/30,000). TMS can cause scalp discomfort and/or headache. Hearing protection is required during TMS to prevent hearing loss or ringing from the machine’s tapping noise.

ECT aims to induce a therapeutic seizure, so we can’t call this a side effect. A seizure might last longer than desired, which can be dangerous. Anesthesia carries cardiopulmonary event risk (1/10,000). ECT can result in memory loss. In most cases, it is for short-term memory; in others, it could be long-term memory loss.

Learn more about the pros and cons of TMS therapy