rTMS vs ECT Treatment

When people first hear about rTMS treatment, some wonder whether it is the same as, or similar to ECT. 

While both use a ‘machine’ to stimulate the brain, the way they work is very different. This page explains and compares the two treatments.

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Comparison – TMS vs ECT

Although both Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) treat depression, the similarities end there.

How They Work

ECT passes electrical currents through electrodes placed on the head to induce seizures. Although ECT patients are given muscle relaxants whilst under the anesthetic, it is common to wake up feeling achy as a result of the seizures. This is an invasive treatment.

TMS uses magnetic pulses to cause neuroplasticity – the brain’s ability to mend and build connections between the nerve cells – and targets only the small area of the brain that is understood to cause the symptoms of depression (the prefrontal cortex). This is a non-invasive treatment.

Because they work so differently, the patient experience for TMS is very different compared to ECT. This table gives a more detailed comparison.

ECT Compared To TMS Treatment

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Electroconvulsive Therapy

Technology used: Electrical currents sent through the brain via electrodes

How it works: ECT treatment uses electrical currents to trigger a seizure

Invasive? Carried out under general anaesthetic with muscle relaxants to calm convulsions

Treats: Severe and treatment-resistant depression, schizophrenia, bipolar disorder, catatonia

Sessions: Usually twice a week for 3 to 6 weeks

   NICE approved


   In patient treatment

  Hours/days to recover – patients can expect to feel drowsy and unwell after a seizure and general anaesthetic

ECT Success Rate:

ECT improvements are hard to track, although reports suggest around 48% of patients enter remission

ECT Side Effects:

Headache 33%, Memory problems 18%, Cognitive problems 17%, Confusion 16%, Muscle aches 13%

Serious side effects causing death and morbidity with cardiovascular and pulmonary complications occur in a very small number

Prolonged seizures can occur in 1-2%

TMS Brain


Transcranial Magnetic Stimulation

Technology used: Magnetic impulses applied to a maximum 3cm depth around the brain

How it works: TMS treatment gradually stimulates or modulates targeted brain pathways/areas

Invasive? No anaesthetic is required – patient is awake and relaxed

Treats: Depression, addictions, anxiety, PTSD, OCD, BPD, DPD, chronic primary insomnia

Sessions: For depression, expect daily sessions for 3 weeks

   NICE approved


   Outpatient treatment

  Immediate recovery – patients can generally return straight to work or normal activities

TMS Success Rate:

60% of Smart TMS patients treated for depression with TMS have into remission since we started in 2015

TMS Side Effects:

Mild headaches,
Mild fatigue,
Low risk of seizures (1 in 50,000)

Facts about ECT

The risks of ECT may be greater in older people and ECT should only be given in this group with considerable caution. 

The remission rate in patients with treatment resistant depression with ECT is about 50%. In most published studies the rates of recovery with ECT are higher than with rTMS by about 10%.  Our remission rate of 60% is higher than this because we probably have a higher functioning population to start with.

Failure to respond to ECT does not necessarily mean that the person will fail to respond to rTMS.

More Information – TMS vs ECT

ECT was first introduced in the 1940s and is now used to treat the most severe cases of depression, usually after all antidepressant and therapy combinations have been tried without success.

TMS has been used since the 1980s and can be used to treat a large majority of patients living with depression and other mental health conditions.

ECT is more invasive than TMS and requires the patient to have a general anesthetic, which carries its own risks and restrictions.

A session of TMS takes 30 minutes and you are able to go about your day as normal immediately afterwards, without any need to go into hospital or disrupt your usual routine.

Electroconvulsive Therapy is a treatment that involves sending an electric current through the brain. This will then trigger an epileptic seizure, although the physical element of this is generally minimal as muscle relaxants and general anaesthetic minimise the convulsions so that it looks more like a twitch.

The treatment has been shown to relieve the symptoms of some mental health problems including treatment-resistant depression, catatonia, bipolar disorder (manic depression).

The treatment is given under a general anaesthetic and using muscle relaxants, so that your muscles only twitch slightly, and your body does not convulse during the seizure.

ECT has something of a bad reputation. It is an invasive procedure which may leave unpleasant side-effects. In the past, it may have been used without the patient’s consent and/or not under general anaesthetic. Some people have a bad experience of ECT, but for others it has proven helpful in breaking the cycle of mental illness.

Transcranial Magnetic Stimulation is a treatment that delivers magnetic impulses to the brain pathways and areas associated with the condition in order to gradually stimulate or modulate them.

The process is referred to as neuroplasticity and uses the brain’s ability to mend and build connections between the nerve cells.

Treatment is targeted to the specific zones affected.

ECT Treatment

NHS: ECT may be used for depressive illness, mania, catatonia and,
occasionally, schizophrenia

Private: ECT available at selected specialist private mental health hospitals

TMS Treatment

NHS: Very limited local availability for TMS on the NHS. See NHS Availability

Private: TMS is available nationwide at Smart TMS. See clinic locations

Is TMS right for you?

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