TMS VS ECT: What’s the Difference?
What is the Difference Between TMS and ECT?
Approximately one in five U.S. adults will be diagnosed with a mental health condition at some point in their lives. The current DSM V recognizes over 200 forms of diagnosable mental health disorders. Disorders can range in symptom severity, duration, and manifestation. While most people will respond to some combination of therapy and medication, a portion of mental health patients will not see any therapeutic reduction in symptoms with conventional treatment methods. Treatment-resistance is especially pronounced with clinical depression, and around 30% of all people with a depressive disorder will not respond to medications and therapy alone. For these patients, finding relief from their symptoms is imperative. Depression, left untreated, has a high rate of morbidity and is the leading cause of suicide.
Deep brain stimulation therapies are ideal for treating mental health disorder symptoms that won’t respond to medications and talk therapy alone. For patients with severe depression and other mental health disorders, transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) can alleviate symptoms quickly and with few side effects. But what is the difference between TMS and ECT? While both treatments target the brain, they are incredibly different.
What is the main difference between TMS and ECT?
TMS
TMS uses a magnetic coil to stimulate specific regions of the brain that are thought to play a role in depression symptoms. It is a non-invasive, outpatient procedure, and patients are awake while clinicians administer magnetic pulses to the brain.
ECT
ECT uses electric currents to induce a seizure in a sedated patient’s brain. ECT does not target specific areas but stimulates the brain to create essential neurotransmitters that influence mental health disorder symptoms.
Where is each procedure performed?
TMS can be administered in a doctor’s office. Patients aren’t sedated, and the procedure does not require expensive monitoring equipment.
In contrast, ECT procedures are conducted in hospital settings.
What type of doctor can administer either of these treatments?
TMS
TMS is a non-invasive procedure that does not require anesthetics or other medications to be administered before treatment. Anyone with the proper training and certifications to apply TMS can do the procedure. However, a licensed doctor must be present when the procedure is being performed.
ECT
ECT is a more complex and invasive technique for treating mental health disorder symptoms. The patient has to be sedated while undergoing ECT. A team of medical professionals must be present during the procedure. Teams typically include the following types of clinicians:
- Anesthesiologist
- Nurse
- Physician assistant
- Psychiatrist
How long does either procedure last?
TMS
TMS procedures last between a half hour to one hour. Most patients will undergo one TMS session every weekday for several weeks. Patients can return to work or school immediately after a treatment session.
ECT
ECT treatments last about one hour as well. The procedure itself lasts about ten to twenty minutes, while the rest of the hour is spent with the patient recovering in a room inside the hospital. Patients usually need to rest for a day after a treatment session. Patients usually require two or three procedures a week for anywhere from two weeks to four weeks.
How many times must a patient receive treatment for each procedure?
TMS
Most courses of TMS treatment last for four to six weeks, although some patients may need more treatments while others will respond favorably in less time. It is possible for patients to undergo TMS several times during their lifetime when symptoms recur. Mental health disorders are chronic conditions and relapses often happen. That doesn’t mean treatment was unsuccessful. Relapse is part and parcel to chronic health conditions.
ECT
ECT sessions tend to occur at two to three sessions per week for two to four weeks, with most patients receiving anywhere from six to twelve separate ECT sessions for each course of treatment they may need. Every mental health disorder diagnosis is different, and some patients may need less or more treatment sessions. In depressed patients, between 70 to 90% of ECT patients will experience a remission of symptoms after a course of ECT. However, remission from ECT is often short-lived. Most ECT patients will need to take antidepressant medications after treatment. It is also common for ECT patients to need several rounds of ECT treatment during their lifetimes.
What is the cost difference between ECT and TMS?
TMS treatments are less costly than ECT.
ECT requires more prep work for the doctors and patient, and it also involves the use of anesthesia and other medications. Patients must also recover in the hospital room, which also adds to the overall price tag.
On average, ECT will cost about $2500 per session, for a total of $25000 for most patients. In contrast, a TMS session will cost somewhere between $400 and $500 per session. The average TMS patient will spend about $15000 for a round of TMS treatment. Most insurance companies will cover ECT. TMS is a newer procedure, and many insurance companies will not cover it. However, that is starting to change, with more and more insurance companies beginning to provide coverage for TMS.
Why would someone get TMS over ECT or vice versa?
Studies have found that ECT is slightly more effective than TMS, but more patients would opt for TMS, especially if their insurance will cover the procedure. TMS is less invasive than ECT, and also comes with fewer side effects. TMS is also useful for alleviating the same type of mental health disorder symptoms that ECT can treat. While most patients would prefer TMS treatment over ECT treatment, more people undergo ECT for treatment-resistant mental health disorders because insurance is more likely to cover the procedure at this time.
What procedure is more dangerous?
TMS
Although TMS is a newer medical treatment than ECT, it’s effects are well-known and have been studied extensively since it was invented in the mid-1980s. TMS is a safer procedure since it does not require the use of anesthesia and sedation. TMS is more targeted too, and won’t affect other bodily systems. The most common side effects of TMS are mild to moderate headache, and tingling where the magnet was placed against the head. The more TMS sessions a person has, the less frequent and severe the side effects will be. TMS treatment does not cause impairment, and people are safe to drive or go back to work or school after treatment. Headaches can be alleviated with common OTC painkillers.
ECT
ECT has been used since 1938, and doctors must follow strict guidelines to administer the treatment. ECT is considered safe in general, but it is also safe for children, pregnant women, and the elderly. Unfortunately, much of the stigma and negatively surrounding ECT originates from when it was first invented and used in the late 1800s and early 1900s. At this point in history, electricity was a relatively new discovery, and people did not fully understand how it worked and what risks were associated with it. Early ECT treatments were often administered without anesthesia and other safety measures. These first-ever ECT treatments sometimes led to bone fractures and severe memory loss, but modern ECT practices have eliminated these risks and complications.
Today, ECT is much safer, and there are no reliable studies on long-term adverse effects of ECT. However, the procedure does come with some side effects that are more disruptive than those seen in TMS. ECT also comes with a slightly elevated risk of medical complications that are not typically seen with TMS.
Most patients who receive ECT treatment will experience some confusion after a session. This can last for a few minutes or a few hours after treatment.
Patients may not know where they are or how they got to the hospital. In rare cases, some patients may experience confusion for a few days after treatment, but this risk is minimal and is usually seen in older adults who undergo ECT.
Short-term memory loss is also a common side effect. Patients may forget what they did right before a procedure, and in rare cases may have difficulty recalling memories from days to weeks or months before treatment. Short-term memory loss usually improves within the weeks or months after ECT treatments have stopped.
ECT also comes with a few physical side effects. Some patients will get headaches, or jaw and facial muscle aches. Nausea is also common. These side effects are usually mild and can be treated with medication and rest after a treatment session.
Anytime someone has to undergo a medical procedure that requires anesthesia, and there will be a risk of medical complications. The ECT procedure itself, and the anesthesia needed to perform the procedure will raise heart rate and blood pressure. People with cardiovascular issues should not undergo ECT treatments.
What are the common misconceptions about each procedure?
TMS
TMS has been around since the 1980s, but its use as a treatment method for depression and other mental health disorders is not that well known. Many people who are not familiar with TMS sometimes think it requires sedation or may come with severe risks and complications. But TMS is a non-invasive procedure that will not cause any issues with a patient’s memory.
ECT
Pop culture and stories from ECT’s early days in the late Victorian era have given it a negative reputation. Early ECT treatment was not fully understood, and doctors would often administer ECT without sedation, or other safety measures to prevent harm and discomfort to the patient. Permanent memory loss, cardiac arrest, and bone fractures would sometimes happen during early, primitive ECT treatments. Current guidelines for ECT are very safe, and the amount of electricity used in ECT is minimal, and only enough to induce a mild, quick seizure.
Why would someone undergo TMS treatment?
TMS is used to treat and alleviate symptoms from a variety of mental health disorders. Most commonly, TMS is used for patients with treatment-resistant depression (TRD). A patient is considered to have TRD if they have tried at least one antidepressant medication and did not see an improvement in symptoms. TMS can be used for several types of clinical depression subtypes, including major depressive disorder and postpartum depression. TMS has also been used on patients with OCD, a type of anxiety disorder, successfully. TMS is typically not recommended for bipolar patients because it can induce a manic episode.
Why would someone use ECT?
ECT can be used for patients with TRD. ECT is also effective for patients with psychotic symptoms, which can happen with the depression subtype psychotic depression. Patients with severe bipolar accompanied by psychotic symptoms and schizophrenia can also benefit from ECT since the treatment works quickly.
ECT is rarely used as a first-line treatment and is often the last resort where other, less invasive procedures have failed to alleviate severe symptoms, and a patient is at risk of harming themselves or others.
What are the current statistics on ECT and TMS usage and success rates?
TMS
In the last ten years, there have been more than 1.7 million TMS treatments in the U.S. Currently, more than 36 different insurance companies cover TMS treatment. For patients with TRD, TMS can induce complete remission of symptoms in about 30% of patients. Around 60% will go on to experience a marked reduction in symptom severity.
ECT
In the U.S., around 100,000 people receive ECT treatment every year. ECT is useful for reducing severe mental health disorder symptoms in 70% to 90% of cases, with many patients noting a reduction in symptoms after just two treatments of ECT. However, 74% of ECT patients will experience memory issues for several weeks to months after treatment has ended, with around 30% stating that memory never returns to normal after ECT.
Both ECT and TMS can offer relief for people with TRD. But ECT comes with a broader range of side effects and risks and is usually only administered as a last resort for patients with severe, psychotic features that make them an immediate danger to themselves or others. TMS is far less invasive and less risky.
ECT and TMS are acronyms for two different therapies that treat depression by stimulating the brain. ECT, or electroconvulsive therapy, uses electrodes attached to the scalp to shock the brain. TMS, or transcranial magnetic stimulation, uses a magnetic coil to send impulses to the brain. Although both techniques are efficient, TMS is a non-invasive, outpatient treatment. ECT requires sedation and has more side effects.
What Is ECT?
According to Psychology Today, ECT has been around for almost 80 years, and it’s still the most effective therapy for treatment-resistant depression. Researchers don’t understand how it works, but they know electrical current induces seizures in the brain’s frontal lobes. ECT fell out of favor in the 1970s when new antidepressants and sedatives entered the market and changed how doctors treated mental illnesses.
Technology for ECT has improved in recent years, becoming a respected method for treating cases of depression that haven’t responded to medication or psychotherapy. It is also beneficial when patients need fast results and can’t wait for other treatments to take effect. Approximately 100,000 Americans and 1,000,000 people around the world receive ECT each year.
A medical team is needed to sedate and administer ECT. Side effects have improved drastically over the years but may include short-term confusion, nausea, or muscle aches in the head, jaw, or face. Symptoms are generally mild and respond to rest and medication. There is also a slight risk that accompanies any procedure done under anesthesia.
What Is TMS?
TMS therapy, which usually occurs in an outpatient setting, does not cause brain seizures, and there is no need for sedation. The patient sits in a comfortable chair while a magnetic coil sends bursts of magnetic energy to the scalp. A session lasts less than an hour and requires no rest or recovery. The doctor gives the patient treatment that lasts 4 to 6 weeks, five days per week.
There are few side effects, but a slight headache or tingling on the scalp may follow a session. Harvard Health Publishing reported that 50% to 60% of depressed patients in one study had not responded to medications but had a “clinically meaningful response with TMS.” Of those, about one in three had full remission. Although individuals vary, improvement usually lasts a little over one year. The good news is that patients can repeat TMS when symptoms return. If someone doesn’t respond to TMS, ECT may still be an option.
Pulse TMS Can Help
Our experienced team administers transcranial magnetic stimulation to patients who haven’t responded to traditional treatments or those who want conventional medicine alternatives. We can also answer questions like these:
- What is TMS?
- What is ECT?
- Is ECT or TMS better for me?
- Where can I find treatment?
- Will insurance cover my care?
- Can I go back to work after my session?
The FDA has approved the use of TMS for treating depression. Contact us today for more information about overcoming depression or OCD with the help of transcranial magnetic stimulation.
Updated on 3/5/2021
