When it comes to treating severe depression that hasn’t improved with medication or talk therapy, two common options often come up: ECT (Electroconvulsive Therapy) and TMS (Transcranial Magnetic Stimulation). While both are evidence-based treatments for major depressive disorder, they work in very different ways and have distinct considerations—like how effective they are, what recovery looks like, and the potential side effects. In this guide, we’ll break down what ECT and TMS are, how they compare, and who might benefit most from each approach so you can make an informed decision about your mental health care.
What is ECT (Electroconvulsive Therapy)?
Electroconvulsive therapy, or ECT, is one of the oldest and most well-researched treatments for severe depression. During the treatment, a small electrical current is delivered to the brain while the patient is under general anesthesia. This electrical current causes a brief, controlled seizure that can help “reset” brain chemistry and improve mood symptoms.
ECT is typically used for individuals with severe, treatment-resistant depression, especially when rapid symptom relief is needed. Appropriate cases include those with suicidal ideation, catatonia, or psychotic features. It’s often administered in a hospital or specialized clinic and usually requires multiple sessions over the course of a few weeks.
What is TMS (Transcranial Magnetic Stimulation)?
Transcranial magnetic stimulation, or TMS, is a non-invasive, outpatient treatment that uses magnetic pulses to stimulate nerve cells in specific areas of the brain involved in mood regulation. TMS does not require general anesthesia or cause seizure activity.
TMS therapy is FDA-approved for treatment-resistant depression and is generally well-tolerated, with most patients able to return to daily activities immediately after a session. Treatments are administered five days per week over several weeks in a psychiatry office.
TMS is becoming an increasingly popular option for treatment-resistant depression due to its gentle approach, minimal side effects, and proven success with minimizing depressive symptoms. It was recently FDA cleared for TMS for adolescents and is a new powerful modality for treating difficult to treat depression in this age group.
ECT vs. TMS
| Modality | ECT | TMS |
|---|---|---|
| Method | Electrical stimulation under anesthesia | Magnetic stimulation while awake |
| Invasiveness | Requires sedation and seizure induction | Non-invasive, no sedation |
| Setting | Hospital or specialized clinic | Outpatient clinic |
| Recovery Time | May require hours to recover post-treatment | Immediate return to activities |
| Sessions | 2–3 times per week for 2–4 weeks | 5 times per week for 4–6 weeks |
| Ages | 18+ | 15+ |
What Are the Side Effects of ECT and TMS?
ECT:
- Short-term memory loss (especially around time of treatment)
- Confusion
- Headaches
- Nausea or muscle aches from anesthesia
TMS:
- Scalp discomfort at treatment site
- Headache during or after session
- Mild fatigue
Serious side effects with either treatment are rare, but the risk profile is typically lower with TMS since it doesn’t involve sedation or seizures.
Is ECT or TMS More Effective for Depression?
Both ECT and TMS have been shown to improve symptoms of depression, especially when other treatments have failed. ECT tends to have a higher success rate in severe, treatment-resistant, or psychotic depression. TMS has strong evidence for effectiveness with moderate to severe depression that hasn’t responded to multiple antidepressants. While TMS may take longer to show full results compared to ECT, many patients favor its less invasive nature and minimal downtime.
Who is a Good Candidate for ECT or TMS?
ECT may be right for you if:
- You have severe depression with suicidal thoughts
- You experience psychotic features or catatonia
- You’ve tried multiple medications and therapies without relief
- You need rapid symptom improvement
TMS may be right for you if:
- You have treatment-resistant depression without psychosis
- You prefer a non-invasive option
- You want to avoid anesthesia or sedation
- You’re looking for treatment that allows for fast return to daily activities
Does Insurance Cover ECT or TMS Therapy?
Yes! Most major insurance plans cover both ECT and TMS when certain criteria are met, such as diagnosis of major depressive disorder and documented failure of previous treatments (typically two or more antidepressants).
We recommend contacting your insurance provider for specific coverage details or working with our team to help with guidance through the authorization process.
Choosing the Right Treatment for You
Choosing between ECT and TMS can feel overwhelming, but the good news is that you don’t have to make the decision alone. At A Better Day Psychiatry, we favor a personalized, compassionate approach to patient care and will help you explore all your options based on your unique needs.
If you’re struggling with depression and wondering whether ECT or TMS might help, we’re here to support you every step of the way.
Schedule an Intake Appointment
Ready to take the next step in your mental health journey? Contact us to schedule an intake appointment and learn more about ECT, TMS, or other treatments that might be right for you.