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Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) are both treatments used for treatment-resistant depression and other mood disorders. The goal of both treatments is to help patients achieve full remission from depression, meaning the patient is no longer diagnosed with depression. While both depression treatments stimulate the brain, they operate quite differently. Despite the differences, TMS is often confused with ECT and vice versa. In this post, we will compare the two treatments, their different protocols, and side effects.

TMS vs ECT

TMS vs ECT for depressionECT has been used to treat depression since the 1940s. At the time, it was considered a revolutionary breakthrough in the treatment of mental illness. ECT works by applying a direct electrical current to the patient’s brain to induce a small seizure. This electricity-induced seizure “resets” the brain, helping it to overcome severe depression and other mental disorders. Until recently, ECT has been considered to be the gold standard in treatment for severe depression and treatment-resistant depression. (Source)

TMS is a newer depression treatment which received FDA approval as a treatment for major depressive disorder in 2008. Instead of passing electric current through the brain, TMS works by means of magnetic pulses which target specific areas of the brain associated with mood control. These magnetic pulses induce a stimulus/response mechanism, stimulating the brain to generate new, healthy neural pathways.

Treatment Protocol: TMS vs ECT

TMS is provided in an outpatient setting. A patient sits in a comfortable chair while a trained technician uses a TMS device to administer the magnetic pulses. Each TMS session lasts 20 to 30 minutes long, with a typical course of treatment consisting of five days a week over six or seven weeks. Patients are fully alert during treatment and the treatment itself is not painful. After each TMS session, patients are able to drive a car, return to work, and conduct business as usual.

ECT can be provided as either an inpatient or outpatient treatment. Patients are given muscle relaxers and are sedated under general anesthesia throughout the treatment, which lasts up to an hour. Afterward, patients should refrain from driving, returning to work, or making important decisions for up to two weeks following treatment. ECT treatment is typically administered for two to three sessions per week over two to four weeks.

Side Effects: TMS vs ECT

The most common side effect of TMS is a mild headache during and shortly after the session. If a patient does experience headaches, the headaches often lessen in severity or discontinue entirely as the patient becomes accustomed to the treatment over multiple sessions. Other side effects of TMS may include facial twitching and a slight tingling sensation on the scalp.

The most common side effects of ECT include nausea, headache, fatigue, confusion, and memory loss, which may last several hours. Long-term memory deficits, though rare, are also a potential complication of ECT. There is also the potential for complications due to anesthesia. The severity of potential side effects is much more severe for ECT than for TMS. (Source)

Who Is Eligible for TMS?

Patients with mild to severe depression may benefit from TMS. In addition, TMS is used to treat OCD, anxiety, PTSD, major depressive disorder, postpartum depression, and treatment-resistant depression. While most insurance companies cover TMS treatment in their plans, they typically require patients to attempt other treatment options first, such as antidepressants and therapy. If patients choose to pay out of pocket, these prerequisites do not apply and TMS can be administered anytime.

Who Is Eligible for ECT?

Similar to TMS, ECT is a treatment option for patients who have failed to respond to other treatments like medication and therapy. Now that safer alternatives are available (such as TMS), ECT is usually reserved as a treatment of last resort for severe cases of depression, mania, psychosis, or other mood disorders. ECT is not considered to be a first-line, second-line, or even third-line treatment option.

Treatment Efficacy

Both TMS and ECT have been proven to be effective in treating depression and other mood disorders. Patients can achieve a successful outcome (remission of depression) with either treatment option. For most patients and providers, the choice between TMS and ECT is decided based on factors such as convenience, how well the patient will tolerate the treatment, and the potential negative side effects of each treatment option.

Conclusion

Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective treatments for depression, but they work in different ways and have drastically different risks associated with treatment. The decision to choose one over the other should be made in consultation with a qualified healthcare provider who can evaluate the individual’s specific needs and circumstances.

In general, ECT is typically reserved for people with severe depression who have not responded to other treatments, particularly where there is serious concern about the patient’s safety due to their condition. If the patient meets the criteria for TMS, in most cases, the patient should be encouraged to try TMS before trying ECT.

TMS is appropriate for people with milder depression or those who prefer a non-invasive treatment approach. TMS is more convenient for the patient than ECT as it does not require admission to a hospital or to be placed under general anesthesia. Patients find it easier to fit TMS into their schedule, as they can return to work, drive a car, and perform other regular tasks immediately following a TMS session.

Patients who have already tried TMS without adequate relief may find relief through ECT, or they may find relief by undergoing another series of TMS treatments. Likewise, patients who have tried ECT may also be good candidates for TMS. These decisions are best made in consultation with a qualified psychiatrist or psychiatric mental health nurse practitioner.

Utah TMS Treatment Locations

TMS treatment for depression is a safe, well-tolerated procedure that is convenient for patients and has minimal side effects. Patients can be treated with TMS in Utah at two convenient Ampelis Health locations, in Highland (Utah County) and South Ogden. To see if TMS is the right treatment option for you, call Ampelis Health today at 435-776-5909.

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