As a psychiatrist specializing in interventional psychiatry, I meet a lot of people
struggling with treatment-resistant depression who confuse transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). Considering the similarities between the two procedures, it’s completely understandable. Both treatments involve placing an apparatus on the head, both use varying amounts of electricity to change the electrical activity of the brain, and both are known treatments for depression. The differences lie in how each procedure is conducted, and who they are appropriate for.
ECT is a procedure that has been around since the 1930s, and has been used to treat a wide range of psychiatric conditions including depression, bipolar mania or bipolar depression, schizoaffective disorder, schizophrenia, catatonia, and others. While horrific images from the 1975 film One Flew Over the Cuckoo’s Nest likely come to mind, in reality, ECT is a safe, effective, and simple procedure that no longer resembles that shown in the cult classic. During the treatment, a patient receives as anesthetic to fall asleep and a muscle relaxant to relax their body, and a small amount of electricity is applied to the scalp that activates a brief, controlled seizure of approximately 30-60 seconds which the brain shuts off on its own. Unlike the violent shaking shown in movies like One Flew Over the Cuckoo’s Nest, with modern ECT, the seizure is nearly undetectable unless you are looking at the computer monitor. The entire treatment
takes only 3-5 minutes to complete. After that, the patient is monitored for a period of time until they wake up and feel steady enough to leave. Due to the effects of the treatment and anesthesia, patients are restricted from driving, and are encouraged to take it easy for the remainder of treatment days.
Most patients require a course of 6-12 treatments (typically three treatments per week), and some patients are helped by a maintenance treatment every 1-4 weeks, depending on their needs. Side effects of this treatment can include headaches, muscle aches (largely due to the medication used to relax the body rather than from the seizure itself), nausea from the anesthetic, and short-term memory loss which is expected to resolve within weeks of stopping treatments. There is a smaller r isk of permanent memory loss, especially for those who have had several courses of ECT over time. Due to the relative invasiveness of ECT, and the negative, misinformed stigma associated with it, it is often seen as a “last resort;’ although that shouldn’t necessarily be the case given that it is one of the most effective treatments for depression and other psychiatric conditions.
TMS is a procedure that has been FDA approved since 2009, and while it doesn’t have the same breadth of treatment indications as ECT, it can be used to treat treatment resistant depression, anxiety, obsessive-compulsive disorder (OCD), certain substance use disorders, chronic pain, migraine headaches, and is in the process of being studied for bipolar depression and schizophrenia. It involves placing a magnet over a specific area of a patient’s scalp (depending on the condition being treated) which sends small pulses to the brain to increase and alter the electrical activity in that area. To patients, this can feel like a tapping sensation as the magnet is rapidly sending pulses. There is no anesthesia or muscle relaxant involved, no seizure being generated, and no down-time afterwards. Patients can drive themselves to and from appointments, work, go to school, and live their lives generally unrestricted.
Treatment course lengths vary depending on the condition being treated. For treatment-resistant depression, a course involves 36 total treatments, the first 30 occurring Monday-Friday for 6 weeks, followed by 6 treatments tapered over 3 weeks. Each treatment itself is brief, ranging from 10-20 minutes. Side effects of TMS are infrequent, with some people experiencing mild headaches or scalp tenderness in the site of application. TMS can be a safe and effective option for those who have been unable to tolerate the side effects of other treatments, including medications or ECT.
If you are interested in learning more about TMS and if it could be a good option for you, please click on our Services tab or call to speak with one of our doctors at Polaris Psychiatry at 860-846-7137.
