Transcranial Magnetic Stimulation vs. ECT for Depression

Transcranial Magnetic Stimulation vs. ECT for Depression

Transcranial magnetic stimulation is an option for depression treatment and may be an alternative, for some, to electroconvulsive therapy. Transcranial magnetic stimulation (when used as a treatment for depression known as repetitive transcranial magnetic stimulation or rTMS) is actually similar to electroconvulsive therapy (ECT) in that it’s also a neuromodulation technique. It does differ, though, as rTMS is much less invasive and has a very favorable side effect profile, particularly when compared to ECT. There are reasons that people aren’t flocking to rTMS as a depression treatment, though.

[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]

[I’ll just bring up here that I am not a doctor and my opinions are just those of a writer who knows a lot of stuff. If you’re concerned about anything I’ve said or if you’re considering this treatment, you need to talk to an actual doctor.]

What is Repetitive Transcranial Magnetic Stimulation (rTMS)?

In short, rTMS uses a strong magnetic field to modulate your neurons. It’s a big, fancy machine, the arm of which they put over various parts of your brain and create this magnetic field. It makes an awful thumping racket, from what I hear. Here I wrote more about rTMS as a depression treatment.

Does rTMS Work Compared to Electroconvulsive Therapy?

As some of you may know, ECT is the most effective, known treatment for depression (including bipolar depression). Numbers vary but it helps around 80% of the people who are treated by it.

However, ECT has an unfortunate side effect profile in that it causes seizures and thus can cause problems with you brain, memory, particularly. It’s common for one who undergoes ECT to not remember the time around the treatment. Some people have memory and cognitive horror stories from ECT but in modern day, these are rare. (There are other issues like headaches as well.) (You can read a whole lot about ECT here. You can also read my list of pros and cons of ECT here.)

RTMS, on the other hand, has very few side effects. The big thing that people complain about is headaches – which is obviously not a huge deal, all things considered.

But is ECT better than rTMS for depression? In my opinion, I suspect more people would respond positively to ECT than to rTMS. That said, in some studies, people did just as well. (I don’t have time for a thorough research analysis at the moment.) Of course, ECT tends to work faster (like, for some people, they see positive changes in one session). But, if you’re weighing both options and you have access to both, I would say that rTMS is the better option to try first because of the side effect profile. ECT can always be a backup option if it doesn’t work.

What’s Wrong with rTMS?

Well, in theory, there’s little wrong with rTMS. There is the issue of causing mania or hypomania in patients. There have been case reports of this but it appears rare.

You also cannot have rTMS at this time if you have had a vagus nerve stimulator implanted. (There are other contraindications, too, such as having a seizure disorder.)

The problem with rTMS vs. ECT for depression isn’t the treatment, per se, but rather the cost.

RTMS is a depression treatment and so is ECT. Which is better to treat depression? Should you choose ECT or rTMS to treat depression?The Cost of rTMS

Costs of rTMS vary, of course, according from whom you are receiving it. Unfortunately, rTMS machines are extremely expensive (think $30,000 and up) and doctors have to bear the cost of this plus all the associated costs such as the cost of actually doing the treatment at a hospital or specialized clinic.

RTMS costs the patient between $6,000 and $12,000.

And, of course, the cost is much higher for many who have to get to a center that actually offers rTMS (it’s not offered in too many places at this point due to the cost). You’ll likely find it less expensive in Canada, but, then, you’d have to get to Canada. (I know a Vancouver hospital does it.)

This is because, like with ECT, you don’t get just one treatment. You needed a series of treatments held, typically, three days a week, twice a day, over weeks in order to see the benefits.

And, I don’t have to tell you that many insurance companies in the United States will not cover this treatment and will call it “experimental” in spite of the fact that it is Food and Drug Administration approved for the treatment of treatment-resistant depression.

(In Canada, some provinces do actually cover the cost. I believe Ontario and Manitoba do.)

ECT, on the other hand, is almost always covered by insurance.

Maintenance rTMS

And, again, like with ECT, some require maintenance rTMS afterwards. Usually, with ECT, doctors try to stabilize patients on medication after they respond to ECT so that maintenance ECT is not needed, although for some people it is and some people choose it over other depression treatment methods.

It looks like many people who respond to rTMS will need maintenance treatments which will cost thousands of dollars per year. (One clinic I looked at told patients to simply expect maintenance treatment.)

Depression Treatment: rTMS vs. ECT

So, in short, I’m sad to say that while rTMS looks like a really good treatment for depression, it’s totally out of reach for many people. And even if, somehow, you scraped together the money for rTMS, of course, there is no guarantee that it would work for you so you might spend everything you have only to find you are where you started.

If you have the money, I say seek out rTMS for hard-to-treat or treatment-resistant depression. If you’re in that camp, though, and you can’t afford it, in some cases ECT may still be your best option.

Inset image by Flickr user Niccolò Salvi.

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