The Differences Between TMS and ECT

By: Stuart Porter, NP


Sometimes, when people first hear about transcranial magnetic stimulation (TMS), they think it is something like electroconvulsive therapy (ECT). However, while both treatments involve brain stimulation, are often used to treat treatment-resistant depression and other mood disorders, and are covered by most insurances, TMS and ECT have some fundamental differences.

What Is TMS?

TMS stands for transcranial magnetic stimulation . TMS uses magnetic pulses to stimulate the areas of the brain that are affected by depression, OCD, and other mental illnesses. Many TMS patients report a significant reduction in their symptoms, with some even achieving full remission. Research shows that one in three people achieve full remission  from treatment-resistant depression.

TMS consists of 20- to 30-minute treatment sessions five days a week for six weeks, then tapering off to three sessions per week for the final two weeks. During a typical TMS session, a helmet is placed on the patient’s head, and magnetic pulses are delivered to stimulate the nerve cells in precise areas of the brain associated with mood control. Many patients describe the feeling of TMS as a tapping sensation on their head.

During their TMS sessions, patients are encouraged to read, watch videos, play a game on their phone, or participate in any other activity that they can while sitting upright in the TMS chair. It is important to take in positive stimuli while the treatment is in progress.

What Are the Side Effects of TMS?  

The most common side effect of TMS  is a temporary mild headache during and shortly after the TMS session. Most patients report that this headache subsides within the first few weeks of treatment. Other symptoms include facial twitching during treatment and a slight tingling sensation on the scalp at the site of the stimulation.

A very rare side effect is the possibility of seizure. However, research shows occurrences of this is less than 0.1%.  Other studies  show no seizures at all; typically, the most adverse effects a patient may experience are mild to moderate headaches and scalp discomfort that go away shortly after the treatment session.

Who Is Eligible for TMS?  

TMS is approved by the FDA to treat major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) and is covered for those conditions by most insurance plans. TMS is also used successfully as an off-label treatment for:

  • ADHD
  • Anxiety
  • PTSD
  • Addiction
  • Autism
  • Bipolar disorder
  • Chronic pain
  • Eating disorders
  • Multiple sclerosis (MS)
  • Schizophrenia
  • Stroke rehabilitation
  • Substance abuse

In fact, TMS has been used in Europe to treat these and other disorders with great success.

However, because of the strength of the magnets used in the TMS helmet, you may not be able to receive TMS if you have any metal fragments in your head, including:  

  • Aneurysm clips or coils 
  • Bullet fragments
  • Cochlear implants
  • Electrodes for monitoring brain activity
  • Implanted stimulators
  • Implanted vagus nerve or deep brain stimulators
  • Implanted electrical devices (pacemakers or medication pumps)
  • Magnetic implants
  • Stents
  • Another metal object or implant 

Talk to your provider if you have any one of these or a similar implant before you start TMS. And as stated earlier, in very rare cases, TMS can also cause seizures, so if you have a history of seizures, you should let your doctor know. 

What Is ECT?

ECT stands for electroconvulsive therapy . During ECT, a patient is sedated, then electrodes are placed on their scalp to deliver an electric current to the brain to induce a small seizure. ECT can quickly reduce the symptoms of depression as well as mania in those who struggle with mood disorders. 

A patient must be admitted into the hospital for ECT treatment, and they are sedated for the duration of their treatment. If patients are receiving a series of ECT treatments, then they will be advised not to drive, return to work, or make important decisions for up to two weeks following treatment. If they are receiving a maintenance treatment, they may only need 24 hours.

What Are the Side Effects of ECT? 

Immediately following ECT treatment, patients may experience nausea, headache, jaw pain, and/or muscle aches. Patients may also experience confusion, which can last anywhere from a few minutes to a few hours. In more rare cases, typically in older adults, confusion can last several days.  

Another risk of ECT is memory loss, also known as retrograde amnesia. Patients with memory loss usually have trouble remembering events that occurred within the months or weeks leading up to treatment. In rare cases, people can lose their memory of events that happened within years of the treatment. Memory issues usually get better within months to years after treatment.  

Heart and blood pressure can also increase during ECT, which may lead to further complications. And because anesthesia is used during ECT, there may be complications that arise from sedation. Generally, the only people who are at risk for complications from anesthesia are:

  • Older patients
  • Those who are undergoing longer operations
  • Those with previous conditions like sleep apnea, a history of seizures, heart conditions, lung conditions, diabetes, obesity, and alcoholism
  • Those who are on blood thinners

Complications include heart attack, pneumonia, stroke, and in very rare cases, death.

Anesthesia may also cause side effects such as:

  • Temporary confusion and memory loss
  • Dizziness
  • Difficulty urinating
  • Nausea and vomiting
  • Shivering and feeling cold

These side effects tend to go away quickly, however.

Who Is Eligible for ECT? 

ECT is a treatment option for patients who can’t tolerate the side effects of medication or prefer ECT to medication. ECT may also be an option for women who are pregnant and can’t take medication. Because ECT can quickly get rid of symptoms, it is also a good option in the following cases:  

  • When a patient refuses food and that leads to nutritional deficiencies 
  • When other medical ailments prevent the use of antidepressant medication 
  • When the patient is in a catatonic stupor
  • When the depression is accompanied by psychotic features
  • When a patient is at risk for suicide
  • When a patient is experiencing severe mania
  • When treating schizophrenia 

TMS vs. ECT: What Are the Differences?

While TMS and ECT have some similarities, there are more distinct differences between the two. First, ECT uses electric currents to induce a seizure, while TMS uses magnetic pulses to stimulate the brain in a non-invasive way. The procedures are also vastly different. TMS is an outpatient procedure, in which the patient stays awake the entire time and can be performed in a doctor’s office in less than 30 minutes. ECT is a procedure typically administered in a hospital with the patient sedated under anesthesia and can require an inpatient stay. 

TMS, by contrast, can be easily fit into a patient’s daily schedule so as not to disrupt one’s routine. A typical session only lasts about 30 minutes, and patients can immediately return to their daily activities following treatment. Patients who receive ECT have to not only schedule a hospital stay, but they may not be able to return to their normal daily activities for up to two weeks.

Lastly, TMS has fewer side effects than ECT. In addition, TMS does not require sedation, saving a patient the added risk, complications and side effects associated with general anesthesia, which is necessary for ECT.  

Can You Get TMS if You’ve Had ECT?

You can get TMS, even if you’ve tried ECT in the past. Neither procedure will diminish the effectiveness of the other. Everyone reacts differently to these procedures, so talk to your doctor about which one would benefit you the most.  

In one study , 12 patients were given TMS who had had failed drug therapy and at least one course of electric convulsive therapy without success. Ten of these patients underwent an adequate dTMS treatment trial, and the results were encouraging. The doctor in charge of the study commented, “We got them to remit…Seven out of those 10 patients had remission from their depression.”

Hopefully, this blog has shed some light on the differences between TMS and ECT. Both can be effective treatments for major depression and other treatment resistant mental health conditions, but depending on your situation, one might be better than the other. It is important to consult with an experienced psychiatrist  to help you weigh your options for treatment. Contact us  at Serenity Mental Health Centers to schedule an appointment with a psychiatrist who can help you find the most effective care plan to combat your symptoms.

Request Appointment

*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.