Understanding Treatment Options for Depression: rTMS vs ECT

Our world has changed a lot in a little over two decades. In the 90s, we entered the third era of globalization, and nobody dreamed that our world would be interconnected and technologically advanced.  

With these many changes and demands, life is moving at a rapid pace and so are mental health problems like depression. According to the WHO, close to 280 million people are suffering from depression. So, in this article, we will help you understand two of the effective treatment options for depression and how they work.

So, let’s begin! 

What is RTMS? 

Let’s start with rTMS. rTMS stands for Repetitive Transcranial Magnetic Stimulation, and it is a neurostimulation technique that is an evidence-based treatment for depression. The therapy is not only used for depression but also for other mental health conditions like PTSD, OCD, anxiety and other psychiatric and neurological disorders like Tourette syndrome. 

How rTMS Works? 

rTMS applies a series of short low-intensity magnetic pulses to the specific areas of the brain to stimulate nerves. In this therapy, doctors would place a special electromagnetic coil on your head which creates an electromagnetic field. The device targets, especially the dorsolateral prefrontal cortex which is a crucial part of the brain involved in the pathogenesis of depression. 

The therapy usually takes 30-60 minutes to complete and once the treatment is completed you can resume your work as usual.  

What is ECT? 

ECT, or electroconvulsive therapy, is probably the oldest and most effective treatment for treatment-resistant cases of depression. Similar to rTMS, ECT is also being used for many mental conditions like catatonia, bipolar disorders, schizophrenia, and even severe suicidal ideation. The main goal of the treatment is to provide relief from symptoms of mental health problems. 

How Does ECT Work? 

Unlike rTMS which directs a low electromagnetic field, ECT passes a small dosage of electric current to the specific location of the brain. These electric currents cause therapeutic seizures within the brain for almost a minute or so. Before the procedure, the doctor will carefully assess the medical condition of the patient and during the procedure, the patient will be given general anesthesia.  

How Effective is ECT vs rTMS for Depression? 

Both electroconvulsive therapy and repetitive transcranial magnetic stimulation have shown great effectiveness in the treatment of depression, especially for depression conditions that aren’t responding to traditional treatments like CBT or medications. 

Though both are great options for treating depression, based on available data and studies, ECT is considered more effective than rTMS. Studies suggest that the response rate of ECT is between 75%-83% and the remission rate is between 30% and 50%, whereas for rTMS the response rate ranges from 60% to 80% and the remission rate is around 30%.  

Main Differences Between rTMS and ECT 

As we have already informed you both rTMS and ECT are great therapy for depression treatment. However, there are a few major differences between these two treatment options. Let’s understand the differences between the two in this segment.  

Mechanism 

One major difference between these treatments is how they work. rTMS, as you know, uses low-intensity magnetic pulses directed to specific areas of the brain to stimulate nerve cells, consequently promoting growth and healing.

ECT sends a low-intensity, controlled electric current to the brain that causes a seizure, which leads to chemical changes in the parts of the brain involved in mood regulation.  

Invasiveness 

While performing ECT, doctors use general anesthesia, and it is more invasive in nature. Under this treatment, doctors administer controlled current through electrodes, which will be placed on the scalp to generate brief seizures. 

rTMS on the other hand is a non-invasive therapy that uses magnetic coils to send pulses to the brain to stimulate nerve cells. This treatment doesn’t require the use of anesthesia or sedatives. 

Level of Discomfort 

As ECT is performed on patients who are under the influence of general anaesthesia, patients do not experience any discomfort during the therapy. However, post-therapy, patients may experience muscle aches, short-term confusion, headaches, etc. 

rTMS is generally considered a painless procedure, however, as a patient you may feel passing discomfort on your scalp. One may feel a tingling sensation and after the therapy, you may experience a mild headache that subsides as the treatment progresses. 

Effects 

In terms of effectiveness, both treatments provide somewhat similar results and provide relief in conditions like depression, especially in severe cases of depression where other treatments are responding. Both treatments help increase the production of brain chemicals that control mood, appetite, and well-being. 

ECT vs rTMS Schedule: Duration and Frequency 

As we know both treatments offer relief from severe cases of depression, now let's understand how long the therapy session lasts and how often you need to undergo the treatment for visible results. 

ECT Duration & Frequency 

The duration and frequency of ECT greatly depends on the condition and severity of the depression or other mental health conditions. However, normally the treatment is 4-6 weeks long with 2-3 sessions per week. The entire procedure of a single session may last 30-60 minutes.  

rTMS Duration & Frequency 

rTMS, a non-invasive treatment and usually takes multiple sessions spread over several weeks, sometimes even take 6 weeks to complete the course. The whole treatment plan may take up to 30 sessions with 5 sessions per week. Based on the condition of the patient, per session may take about 20-30 minutes.  

Cost of ECT vs rTMS 

The cost of each treatment is determined based on factors such as the condition and its severity. However, in comparison, ECT is lot costlier than TMS and can range anywhere between ₹2000-₹10000/ per session. Whereas rTMS cost can range between 5000-7000/ session.  It is also important to keep in mind that the cost of both treatments may vary greatly from city to city and facility to facility. 

ECT vs rTMS: Potential Side Effects 

When we undergo any treatment, there are always concerns related to its side effects. These concerns are valid as sometimes our bodies react differently to medication and procedures. Let’s understand the potential side effects of ECT and rTMS. 

Side Effects of ECT 

Side effects can be categorized into two groups, one where you have common side effects and the other where you have rare side effects.  Some of the common side effects of ECT are short-term memory loss, nausea, headaches, jaw aches, muscle aches, and feeling confused post-treatment.   

Some of the rare side effects include severe reaction to anesthesia, increased blood pressure, heart issues, change in heart rhythm, and death (very rare). 

Side Effects of rTMS 

On the contrary, rTMS is a non-invasive treatment for brain stimulation and doesn’t require implanting electrodes or the use of anesthesia, hence it is generally considered safe. However, there are a few common and uncommon side effects of rTMS and these are scalp discomfort or pain, headache, tingling sensation, twitching of facial muscles, and lightheadedness. Some of the rare effects of rTMS are seizures, emotional highs, and hearing loss.  

Advantages and Disadvantages of rTMS Compared to ECT 

All the treatments, therapies, and medications come with some advantages and disadvantages. It is the same with rTMS too, however, in this section, we will discuss how effective rTMS is compared to ECT. 

The first thing is that rTMS is a lot more affordable than ECT which makes the treatment more accessible to the public and it has fewer side effects.  However, it is also true, that rTMS is less effective and requires more sessions to get the noticeable result.  

Which Treatment Option is Right for You? 

The answer to this question is complicated and depends on individual situations and based on your doctor’s recommendation. Both rTMS and ECT have their advantages and disadvantages in terms of effectiveness, affordability, and side effects, and the choice between them should be made after careful consideration of factors such as medical history, severity of symptoms, and treatment goals.  

It's important to note that the effectiveness of both treatments is backed by scientific research, providing assurance that whichever option you chosen, it is based on evidence-based practice. 

Cadabam’s Help You to Choose Treatment Options for Depression 

Mental health conditions like depression can be challenging and sometimes make it difficult to move forward with life. However, with the right guidance and treatments, one can weather the storm, and this is where Cadabam’s can help you.  

At our advanced facility, our professionals are equipped with years of experience and innovative technologies like Cadabam’s Neuromodulatory Services (CNS) which offer a range of effective non-invasive treatments like rTMS, tDCS, neurofeedback, biofeedback, and ECT to treat a diverse array of mental health conditions. So, let us help you conquer depression and regain control of your life. 

If you are searching for a solution to your problem, Cadabam’s Hospitals can help you with its team of specialized experts. We have been helping thousands of people live healthier and happier lives for 30+ years. We leverage evidence-based approaches and holistic treatment methods to help individuals effectively manage their depression with ECT and rTMS. Get in touch with us today. You can call us at +91 97414 76476. You can even email us at info@cadabamshospitals.com. 

FAQ 

What is the main difference between rTMS and ECT? 

The main difference between rTMS and ECT lies in their mechanisms: rTMS uses magnetic pulses to stimulate specific brain regions non-invasively, while ECT involves passing electrical currents through the brain to induce controlled seizures, typically under anesthesia. 

How long do rTMS and ECT treatments take to show results? 

Results from rTMS typically emerge within 2.5 -4 weeks, with regular sessions lasting about 20-30 minutes. ECT may produce quicker results, often within 3-4 weeks, with treatments administered 2-3 times weekly over several weeks. Individual responses vary; consult your healthcare provider for personalized guidance. 

Can rTMS or ECT cure depression permanently? 

Neither rTMS nor ECT provides permanent cures for depression. However, they can significantly alleviate symptoms for many individuals. Maintenance sessions may be necessary to sustain improvement. It's important to discuss long-term treatment options with your healthcare provider. 

How do I decide between rTMS and ECT for my depression treatment? 

Deciding between rTMS and ECT for depression treatment depends on individual factors and the doctor's advice. Consider your medical history, treatment goals, and preferences. Consult with a healthcare professional for personalized guidance.