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What Are ECT and TMS?

ECT and TMS are two different therapy models, let’s see how they compare.

ECTApplies direct currents to the head to produce a therapeutic seizureHas side effects (e.g., headache, muscle aches, nausea, etc.)Used in the treatment of severe depressionMay be too extreme for some patientsTMSDoes not involve direct electrical currents to patient’s headHas few side effectsMay be used if the patient does not respond to ECT

ECTApplies direct currents to the head to produce a therapeutic seizureHas side effects (e.g., headache, muscle aches, nausea, etc.)Used in the treatment of severe depressionMay be too extreme for some patients

Applies direct currents to the head to produce a therapeutic seizure

Has side effects (e.g., headache, muscle aches, nausea, etc.)

Used in the treatment of severe depression

May be too extreme for some patients

TMSDoes not involve direct electrical currents to patient’s headHas few side effectsMay be used if the patient does not respond to ECT

Does not involve direct electrical currents to patient’s head

Has few side effects

May be used if the patient does not respond to ECT

Andy Behrman:How doesTMSwork differently from electroshock therapy (ECT)? What are the advantages of TMS over medication and ECT?

Other potential side effects of ECT include headache, muscle aches, nausea, transient changes in heart rate, blood pressure, and transient arrhythmias. Long-term memory deficits, although rare, are also a potential complication of ECT. As a result, ECT is rarely considered as a first, second, or even a third-line treatment, except for very aggressive and rapidly deteriorating cases of depression, or depressions that also have psychotic symptoms. The invasive nature and risks of ECT usually require patients to take a temporary leave from work and psychotherapy and employ caregivers or hospitalization.

The Best Online Therapy Services for Depression We Tried and Tested

Deciding Between TMS and ECT

Andy Behrman:ECT has always been considered a last resort. Do you feel it’s the last stop in attempting to stabilize a patient with depression?

Dr. Kira Stein:Every day we are learning new and better ways to treat depression. There is always hope, and I would never say that any treatment is a patient’s “last stop.” New psychotherapies, medications, brain stimulation techniques and even nutritional augmentations are developing all the time.

Andy Behrman:Should TMS ever be considered for patients who have not responded to ECT?

Dr. Kira Stein:Yes, some people who have not responded to ECT have been shown to respond to TMS.

How ECT and TMS Affect Your Brain

Andy Behrman:The goal of medication is to alter brain chemistry. Is it fair to say that electrical or magnetic stimulation do the same thing?

Dr. Kira Stein:It appears that medications, TMS, and ECT all ultimately cause changes in neurotransmitter levels and receptors, as well as increased levels of healing proteins such as brain-derived neurotrophic factor (BDNF). The prefrontal cortex is known to be the part of the brain with the highest level of abnormal connections in depression. It is thought that TMS and ECT normalize frontal lobe activity and connectivity with deeper brain structures. While the knowledge base about the effects of psychiatric treatments has grown in recent years, there is so much more we still have to learn.

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