TMS vs. ECT for Depression | Psychiatry Treatment Centers

If you’re exploring treatment options for depression, you may have come across transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). While both are evidence-based approaches used when medication alone hasn’t been effective, they differ significantly in how they work and what the treatment experience is like.

In this article, we’ll compare ECT and TMS to help you better understand how each treatment works, what sessions involve, and how they differ in safety, comfort, and outcomes.

What is ECT?

ECT is an FDA-approved treatment for certain mental health conditions, including major depressive disorder (MDD), particularly in more severe or treatment-resistant cases. A diagnosis is typically considered treatment resistant when at least two medication trials have not led to meaningful improvement or have caused significant side effects.

A typical course of ECT may include six to 12 sessions over three to four weeks, though the exact number depends on your diagnosis, response to treatment, and other clinical factors.

How ECT works

ECT involves delivering a controlled electrical current to the brain through electrodes placed on the scalp. This current triggers a brief, medically induced seizure that usually lasts less than a minute. While researchers continue to study the exact mechanisms, ECT is believed to prompt changes in brain chemistry that may help reduce severe depressive symptoms.

What an ECT session involves

ECT is performed under general anesthesia, so individuals are not conscious during the procedure. Throughout the session, providers closely monitor vital signs such as heart rate and blood pressure. Brain activity is also monitored using an electroencephalogram (EEG) to ensure the seizure remains controlled and safe.

How long ECT sessions last

The ECT procedure itself typically lasts about five to 10 minutes. However, this does not include the time needed for preparation, anesthesia, and recovery, which can extend the total visit.

What is TMS?

TMS is a noninvasive, FDA-approved outpatient treatment for major depressive disorder, including anxious depression. It is most often used for treatment-resistant depression but may also be recommended for people with moderate to severe symptoms.

A standard course of TMS generally includes 36 sessions delivered over six to eight weeks.

How TMS works

TMS uses electromagnetic pulses to stimulate specific areas of the brain involved in mood regulation. Unlike ECT, TMS does not induce a seizure. Instead, the pulses are designed to increase activity in targeted neuronal networks, which may help improve depressive symptoms over time.

What a TMS session involves

During a TMS session, you’ll sit comfortably while a trained provider positions the treatment device over your head. The device delivers short magnetic pulses to the targeted area of the brain. No anesthesia or sedation is required, and you remain awake throughout the session.

How long TMS sessions last

Although a full course of TMS treatment takes place over several weeks, each individual session typically lasts about 20 minutes. Because TMS is an outpatient treatment, patients are able to return to their normal activities immediately afterward.

ECT vs. TMS: safety considerations

ECT has changed significantly since its early use and is now widely regarded as a safe and effective option for severe depression when clinically appropriate. As with any medical procedure, side effects are possible and may be related to both the treatment and the anesthesia. These can include:

Headache
Fatigue
Nausea
Muscle or jaw soreness
Temporary confusion
Short-term memory changes, which are less common

TMS is generally associated with a lower side effect burden. This is one reason many individuals explore TMS before considering ECT. Side effects with TMS are usually mild and may lessen as treatment continues. These can include:

Headache
Fatigue
Facial twitching or muscle tingling near the treatment area
Lightheadedness, which is uncommon

Responses to both ECT and TMS vary from person to person. Your provider will review potential risks and benefits with you so you can make informed decisions about your care.

Comfort and convenience: ECT vs. TMS

TMS is often considered the more comfortable and convenient option. While ECT is performed under anesthesia, it requires more preparation time and recovery afterward.

TMS sessions are shorter, do not require sedation, and involve little to no downtime. Most people are able to listen to music or relax during treatment and resume daily activities immediately afterward.

Outcomes and effectiveness

According to the American Psychiatric Association, ECT may improve symptoms for up to 80% of people with severe depression. Research on TMS shows that approximately 50% to 60% of individuals experience significant symptom improvement, with about 30% achieving remission. Some studies, including those focused on specific TMS technologies, report higher response rates over 80%.

Treatment outcomes can be influenced by several factors, including: