When antidepressants aren’t working, people with depression may turn to brain stimulation therapies for treatment. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) both provide alternatives to chemical treatments for depression. However, while both use electrical current to activate regions of the brain, in many ways these therapies are quite different.
ECT was invented in the 1930s as a safer alternative to a drug called metrazol but gained a bad reputation in the 1950s, when there is evidence that it was misused in mental hospitals. You may remember ECT from the film adaptation of Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest—fortunately, modern ECT is nothing like this, although it does still carry a negative stigma.
Patients undergoing ECT to treat depression are given anesthesia, so they are not conscious during the therapy, as well as muscle relaxers. A mouth guard is placed beneath their teeth, and their blood pressure, blood oxygen, heart rate, and brain activity are monitored. A doctor places one electrode on each temple and sends an electrical current through the brain to trigger a mild seizure.
ECT is known to provide effective relief for depression—studies have shown that after six to 12 weeks with two to three sessions per week, 70-90{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} of people who tried ECT noticed an improvement. However, this treatment has some drawbacks. In addition to causing temporary headaches, nausea, and confusion, ECT can cause memory issues that last for several months. And while it may be very effective at first, depression often returns only a few weeks or months after treatment.
TMS works differently. It was invented in 1985 and approved by the FDA in 2008 for treating depression in adults who have tried antidepressants without results. During TMS sessions, a small device containing a magnetic coil is placed on the patient’s head. This device sends repetitive magnetic pulses through the head directly into the frontal cortex—a region of the brain that helps regulate mood—without affecting other regions of the brain. These very small bursts of electrical current causes neurons in this region of the brain to fire, which helps the frontal cortex begin to function normally again. Unlike ECT, TMS does not induce a seizure. Patients can stay awake for the whole process (which usually takes 20 to 40 minutes) and are able to drive themselves home afterwards. Most patients receive treatment with TMS five days a week for four to six weeks.
While TMS treatment can cause minor side effects in some patients, these are usually mild headaches or some slight irritation at the treatment site, which typically do not last long. And unlike ECT, TMS does not cause any memory loss.
More research is needed, but the latest studies suggest TMS has positive and long-lasting effects for many patients. A 2013 study presented at the American Psychiatric Association’s Annual Meeting observed the effects of TMS treatment on 257 people with depression and found that over the course of 1 year, 68{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} of patients improved and 45{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} recovered completely. A 2015 review of TMS trials reports that some patients who are recommended to receive ECT may benefit from using TMS instead.
While ECT and TMS can both be beneficial for patients who haven’t overcome their depression with antidepressant medications, how exactly they help the brain heal itself is still mysterious to scientists. New research from Scotland suggests that, over time, ECT weakens the connections in the dorsolateral prefrontal cortex on the left side of the brain, which is believed to be involved in negative thinking. TMS has similarly been found to cause changes in the prefrontal cortex. However, researchers are still working to understand just how passing an electrical current through the brain can create these changes.
TMS Neuro Institute is one of the earliest adopters in using transcranial magnetic stimulation to treat depression in Los Angeles. To schedule a consultation, call 888.823.4867 or book an appointment online here.