You’re not alone.
Depression is now the most common mental illness on the planet.
According to the ADAA, 18% of the adult population in the U.S.A. have depression.
So what now?
TMS & ECT are 2 very different treatments for depression that are highly effective and talked about.
What’s the difference?
We put together the TMS VS ECT post below with all the bells and whistles.
It’s thorough but simple, we promise 😉
Dig into these topics below:
- See the Comparison chart
- What is ECT?
- What is TMS?
- What are the differences and similarities?
- How effective is ECT vs TMS for depression?
- ECT & TMS treatment duration and frequency
- Cost of ECT and TMS
- Side effects of ECT vs TMS
- Pros & Cons of ECT vs TMS
- Getting help with your depression
Comparison Chart – TMS vs ECT
What is ECT and What is TMS?
So is TMS, ECT? No.
Transcranial magnetic stimulation (TMS) and Electroconvulsive therapy (ECT) are 2 different depression treatments.
Both are proven to have very positive effects on your mental health.
They have become increasingly popular in healthcare circles because of their effectiveness.
But what are they? And is one better than the other?
What is ECT?
ECT, or Electroconvulsive therapy, is a very unique procedure.
It has traditionally been used to treat severe psychiatric disorders, such as schizophrenia and psychosis.
However, over the last decade, it has been used more and more often to help cases of depression where traditional treatments have failed.
What to know about ECT:
- Typically performed in an operating room
- Performed under general anesthesia
- Stimulates your brain with electricity, lasts around 5 seconds
- The shock induces a small seizure, lasts about 1 minute
It is important to note that as this seizure is very mild, it will not result in any real muscle movement.
This seizure is thought to almost reset the brain, returning its function to normal in the process.
While immediately after the session (which will last a total of 30 minutes) you might find yourself feeling groggy, ECT has been shown to cause lasting improvements in mood and mental state – which is why it is thought to have some serious benefits for depression.
What to learn more about ECT? Check out our Should You Get ECT Therapy post.
What is TMS?
TMS, or Transcranial magnetic stimulation, is a pretty futuristic treatment for depression.
It uses magnetic fields to stimulate your brain.
Like I said – futuristic.
The results of TMS are impressive. 82% experienced improvement in their depression, 63% achieved complete remission.
What to know about TMS:
- Typically performed in a doctors office
- Fully awake and aware
- MRI strength electromagnetic pulses (not electric shocks like ECT)
- Pulses feel like a light tapping
- 1 session lasts 18 minutes
Once you’re done your session you’re free to go about your day without feeling residual effects.
During a typical TMS session, a small electromagnetic pad is placed on your head. When turned on, this pad sends MRI strength magnetic pulses into the areas of the brain which cause depression symptoms, activating very important nerve cells.
When the electromagnetic pad is placed in the right spot (just above your forehead), it will start to stimulate the key areas of your brain that are responsible for controlling your emotions and your mood.
This entire process essentially increases the neural activity in your brain, leading to lasting improvements in both your mood and your wellbeing.
4 Main Differences and Similarities?
So, as I have already alluded to, there are some pretty large differences between TMS and ECT.
1) Mechanism
ECT uses electrical currents to cause the brain to seize, which acts in a similar manner to a reset button.
TMS uses low-intensity magnetic pulses to stimulate the nerve cells of the brain which facilitates growth and healing.
2) Invasiveness
ECT must be completed in an operating room, as it requires the use of a general anesthetic.
TMS is a much simpler procedure. This means that it can be performed in a doctor’s office without the need for any additional equipment.
3) Level of Discomfort
ECT requires you to be out cold. Depending on how much you like spending time at the doctors, this could be viewed as a positive or a negative.
TMS is much gentler, you can be awake during the treatment. You might experience a little discomfort in the region where the magnet is working.
4) Effects
Despite these obvious differences, both treatments do have some similar effects on your brain.
Both TMS and ECT increase the activity of very important cells found within your brain, which leads to their growth and development. They also increase the production of the key brain chemicals that control your mood and wellbeing.
Subsequently, they can both have a positive impact on your mental health – which leads us to our next point quite nicely.
How Effective is ECT vs TMS for Depression
I guess comparing the 2 treatments is what many people would consider being the crux of the discussion.
I mean, do they both work, and does one work better than the other?
First and foremost, both treatments have been shown to be very effective at helping “cure” depression.
In fact, diving into this in a little more detail, both TMS and ECT have been used successfully to help with treatment-resistant depression – which is a specific type of depression that hasn’t responded to traditional medications (hence the name, being treatment-resistant).
However, this does not necessarily mean that they are created equal.
There is evidence to suggest that of the 2 treatments, ECT has better outcomes. This means that it is generally more effective, causes longer-lasting improvements in mood, and may even result in larger improvements in mental health.
ECT success rate is 75-83% for treating depression.
TMS success rate is 82% seeing significant improvement and 63% complete remission for treating depression.
But there is also a little bit more to this story.
ECT vs TMS – Treatment Duration and Frequency
Before we get into the cost of the two treatments, I wanted to go into a little more detail about what treatment entails.
I have already outlined what a single session looks like, but what about an actual treatment plan?
ECT Duration & Frequency
ECT is normally given 2-3 times per week, for a total commitment of around 10 to 12 sessions being considered normal.
This means that treatment can last up to 6 weeks in total duration.
Because of all that is involved, a single session of ECT can take up to 60 minutes.
TMS Duration & Frequency
When it comes to TMS, most people tend to undertake a 6-week treatment plan, which includes a total of 20 – 30 single sessions of the treatment.
This means that over the 6 weeks, you could have up to 5 sessions per week.
Read more about how TMS works and read TMS reviews.
It is also important to note that a single session of TMS will take about 20 – 30 minutes.
Cost of ECT vs TMS
Now this is where things start getting a little interesting.
While ECT is slightly more effective than TMS, most choose TMS because it’s less expensive and far less invasive.
TMS consistently appears to be about half of the cost of ECT. although costs can certainly vary between states, and even between clinics,
Cost of ECT
It is not uncommon for treatment of ECT, lasting roughly 6 weeks, to cost over $12,000 thousand dollars.
As important as this is, try and remember that there is a reason for this.
ECT requires a surgical theatre, a nurse, and a general anesthetic. The equipment is also typically more expensive, which obviously adds to the cost.
Cost of TMS
A typical 6-week bout of TMS (which can be up to 30 sessions) can cost anywhere between $8,000 and $12,000 with the Neurostar system.
Most clinics offer payment plans through financing if needed.
TMS is covered by health insurance and Medicare in most states.
Find a TMS treatment center near you.
Side effects of ECT vs TMS
As I am sure you can imagine, when applying these sorts of treatments directly to your brain, there can be potential side effects.
These are markedly different between the 2 treatments and vary in severity greatly.
Side Effects of ECT
Side effects occurring with a treatment of ECT tend to be much more common, and also much worse.
Some of these occur as a result of the general anesthetic, while others appear to be a result of the seizure itself.
Common side effects of ECT include:
1) Feeling confused after the treatment (which can last several hours after the treatment)
2) Short term memory loss, that can cause you to forget events that have occurred in the months leading up to the treatment
3) Feeling ill and nauseous after the treatment
4) Headaches
5) Jaw aches
6) Muscle aches
It is also important to note that ECT places quite a bit of stress on the cardiovascular system. This can cause changes in blood pressure, meaning that it may not be the best treatment for people with any type of diagnosed heart disease.
Rare side effects of ECT include:
1) adverse reactions to anesthesia
2) increase blood pressure
3) hyper and hypotension
4) changes in heart rhythm
5) ongoing, lifelong heart issues
6) produce seizures that last longer than expected
Yes, you can die from ECT treatment. 1 in 50,000 dies.
Side Effects of TMS
For the most part, TMS treatments are a breeze when compared to ECT.
This is because TMS uses magnetic impulses rather than electrical currents, and acts to stimulate the brain, rather than induce a seizure.
Common side effects of TMS include:
1) The onset of a mild headache
2) Skin discomfort where the electromagnetic pad has been placed
3) Tingling, spasms, or even twitching of the muscles in your face
4) Feeling light-headed or dizzy
I should also note that these side effects during the treatment tend to disappear after a couple of sessions.
Now, with these minor side effects, some people have also experienced rare side effects. While rare, these do occur in a very small percentage of the people who receive treatment and therefore do need to be considered.
Rare side effects include:
1) The onset of seizures
2) Mania (typically in people with a diagnosed bipolar disorder)
3) Hearing loss (only if there is inadequate ear protection during treatment)
Pros and Cons of TMS vs ECT
Taking all the above into consideration, we can summarise the pros and cons of both treatments quite simply.
TMS is more affordable (covered by most insurance and Medicare), and elicits fewer side effects than ECT. It has also been proven to be an effective treatment for depression.
However, it appears to be less effective than ECT and requires more sessions.
Alternatively, ECT is typically more effective than TMS and can be completed in a much smaller number of sessions (10 vs 30).
However, ECT is more expensive, causes more side effects, and requires the use of a general anesthetic – meaning that it may not be suitable for everyone.
Also, you cannot drive at all during the treatment course of ECT. Someone has to drive you to and from all treatments and sometimes it is recommended not to drive in between treatments bc the seizure and anesthesia can affect coordination and response time. So you’re losing independence and relying on someone else for transportation.
Take Home Message
TMS and ECT are two of the most interesting depression treatments on the planet right now.
Sounding like something out of a science fiction movie, they both impact the brain at a cellular level, causing lasting changes in your mental state – which acts as a catalyst for treating depression.
However, they are not without their differences (which is why we wrote this article in the first place!).
Get Help Today
Need help with your depression? TMS can help you.
Reach out to us at Success TMS. We have 21 depression treatment clinics across the USA.
Get a free consultation, call us now at 888-406-9648 or send us a message here.
Comment Time!
Have you ever tried either of these treatments? Are you thinking of trying ECT or TMS?
We would love to hear your thoughts – drop us a comment below.
11 Comments
Hello Dr. Israel,
I am a 46 year old male that has dealt with depression and anxiety since my early twenties. I have researched both ECT and TMS in the past few years and am finally in a position (insurance/financially) where I am moving forward with one of these treatments. There is a Novant Health clinic near me that performs both procedures now.
My question/concern is about me being disappointed or not happy with the results of either procedure. It makes me very excited to think about going about my life without depression and anxiety. Also it is very scary to think about if my expectations are too high and after treatment period I am not feeling as good as I thought I would.
Could you provide some advice as to how to think and curb expectations leading up to either of these treatments?
Thank You for Your Help!!
David Ridgeway
Hello David,
I am so glad you reached out. First thing to remember is that “depression thinking” wants you to believe that you have a crystal ball and that you can predict the future and the future is negative. However, that is not reality.
The fact that you feel “excited to think about” your life without depression means that you have HOPE, and that is one of your best defenses against the depression thoughts.
Remember, better is better. Any improvement with treatment will bring you much relief, and both ECT and TMS have been shown to be very effective in combating depression.
TMS is less invasive than ECT and does not require any hospitalization time, but both are very helpful in pulling people out of a depressive state.
You should be proud of yourself that you are not leaving any stone unturned; that is a testament to your true strength and who you really are. Be patient with yourself and take it day by day.
Typically improvement does not hit you one day but is more of a gradual process where over time and the course of your treatments you realize that you have had better days, better energy, better motivation. Often times the people around you notice the changes before you realize it yourself; that is very common and perfectly normal.
It is good for you to hope; you are not without options.
Things can be better for you, and you are making the decision to take control of your depression rather than it controlling you. That is a testament to your true strength. Don’t give up.
I wish you all the best.
I am 29 years old, just had my 13th ECT treatment (started 2 months ago) and now I really don’t know if I should continue or stop. I have not really felt any strong benefit from it so far… Sometimes felt a little better but most days I feel like my anxiety has increased overall, also every intervention (medical protocol of anesthesia) is causing me a lot of stress and is a very bad time for me.
Psychiatrists said we should go to at least 15 interventions to conclude on the treatment efficiency, but I don’t know if I can take it any longer… any advice from somebody who has been in a similar situation would be more than welcome!
Now I am looking into TMS, which look much easier to live through, do you think I still have chances of success with this treatment considering ECT has failed? How many TMS interventions should I undergo to optimize my chances of success?
Many thanks for your work, I hope that someday I can put this depression that’s eating my life away behind me for good.
Hello Nicolas,
I am so glad you reached out, which translates to you being determined and leaving no stone unturned.
I understand that ECT is much more involved and can be very stressful. Also, what can happen sometimes if your depression is improving somewhat, but your anxiety is unaffected, it can feel worse as it is more exposed and obvious because you are not battling the depression symptoms as much.
If your doctor recommends 15 ECT treatments, I am sure it is with your best interest in mind, but there is no major danger in stopping in terms of a withdrawal.
Bottom line, don’t give up.
TMS can absolutely still be an option for you. I always recommend completing the 36 treatment course so you have the best chance possible to get the best results possible.
You have to think of it like an antibiotic course that you need to finish. This will be your best chance for success, as everyone feels the improvement at different points in the course.
Also, there is no anesthesia; you are fully awake and can drive yourself to and from treatments.
I am sure TMS would be much less stressful for you in that regard.
Good luck to you.
Hi Charles,
First and foremost, hang in there.
The fact that you responded to ECT in the past is a good sign that you will respond to a non-medication treatment again.
I understand your hesitancy to have another ECT course, as yes, it does limit your ability to drive and can negatively impact your memory.
To answer your question, TMS can be used as a treatment for severe depression in conjunction with antidepressant medications, such as Zoloft.
Working with your prescribing physician, you should be able to resume the Zoloft and titrate to an effective dose while you are getting TMS treatments.
That might be a more effective treatment plan for your depression, using 2 types of intervention simultaneously rather than one at time.
Best of luck to you!
Had Unilateral ECT 15 years ago at age 52 after a 14 month battle with antidepressants. It took 35 treatments to get me back. I am currently fighting depression again. I started TMS early August but after meeting with the therapist I used last round he suggested switching to ECT because we know it worked last time. I have had 12 treatments, 8 unilateral and 4 bilateral with some relief. I am experiencing major headaches, dizziness and body aches. Being on blood thinners has complicated things as well. Since I can’t drive and operate machinery I can not work at our print shop. They also took me off all meds, I was on 50 mg of Zoloft for 15 years and 100 mg for 6 weeks before I started ECT. I called where I started TMS to see if I can resume Zoloft and Treatments there. Being 15 years older makes a big differences!
Any way this treatments TMS or ECT can be performed in an impatient setting? While hospitalized? I have no transportation and no one to drive me. I am disabled (bipolar – clinical depression ) Have been on several medications for depresion and anxiety. I feel they are making me more depressed and hopeless. I am 61 years old .
Hello Jose,
I am sorry you are going through such a difficult time, but glad you are reaching out for help.
To answer your question, TMS can be done in a hospital if that hospital has access to a TMS chair.
However, TMS is considered an “outpatient procedure,” therefore most hospitals do not do TMS on patients currently admitted to the hospital as insurance may not cover the treatments while inpatient and may not cover an inpatient stay for your entire 36 treatment course, which is about 6 weeks.
TMS can absolutely help you with your symptoms and is a great option to try before doing ECT which is more invasive.
I hope you find this information helpful to you. Don’t give up.
Hello Dr. Israel,
We are considering ECT or TMS treatments for my 25 year old daughter who is currently experiencing the negative symptoms of schizophrenia. She was taking 150 mgs of Quetiamine daily for 4 months but stopped taking it about a month ago and is refusing to take any medication. She has been hospitalized 5 times in the past year due to psychosis stemming from her refusal to take her meds. Which treatment would be more effective for her and should she be stabilized on medication before commencing treatment?
Hello Lynne,
I am very sorry for the struggles your daughter is having with managing schizophrenia. This is a very difficult condition to treat for many reasons.
First, we do not fully understand the process in the brain, and second, compliance with medication is very difficult, especially due to the side effects of antipsychotics.
Though TMS is currently being investigated for treating both the positive and negative symptoms of depression, it is not FDA-approved for the treatment of schizophrenia.
ECT, though more invasive, does have more years of evidence to support its potential benefits in treating severe depression, psychotic depression, and the negative symptoms of schizophrenia.
She would need someone to bring her to and from the hospital for her ECT treatments, but this should ensure compliance with attending the treatments.
TMS would require her to come in daily for treatments initially, but this is a much less invasive procedure and would not affect her memory like ECT could. She would not need to be stabilized on medications necessarily before starting either type of treatment.
The hope is that one of these alternative treatments would help stabilize her so that medications, perhaps a long-acting injectable, would be able to maintain her stability.
I was skeptical of this article given the source, but I wanted to thank you for an honest comparison! I feel equipped to make an informed decision now.