Electroconvulsive Therapy vs Transcranial Magnetic Stimulation
ECT stands for electroconvulsive therapy, a treatment that’s been around since about the 1920s and 1930s. It’s a very powerful treatment in that it works on depression, especially in the elderly. Depression that includes psychosis works very quickly. The downsides are that it requires inducing a seizure, although the person’s not conscious for it. It usually involves being done in a hospital. Usually, a patient needs a ride to and from the treatment if they’re not already in the hospital
The most concerning thing about ECT – although it’s a life-saving and very powerful treatment – is that it can have a negative effect on memory. Newer techniques reduce memory loss and most of the time, it comes back but memory impairment is something that makes me not use ECT unless it’s absolutely necessary.
TMS, on the other hand, can be done as an outpatient. A person can drive themselves to and from the treatment. It doesn’t involve any anesthesia or medications being administered and in my experience, it improves memory. I’ve never seen a reduction in memory or cognition. I’ve seen an improvement in working memory and executive function.
The mechanism of action for both of them is still not completely worked out, but ECT used to be a whole brain seizure. Now it’s more towards right-sided ECT so it’s getting more focal. TMS is very focal, depending on which machine one uses. So TMS affects the part of the brain that you want it to. In the short term, it doesn’t affect the other parts of the brain. In the long term, of course, if one part of the brain gets better, then it has an effect on the other parts of the brain. But ECT affects the whole brain at once, almost like rebooting a computer.