TMS vs. ECT: Which is Better For Treatment Resistant Depression?

misc image

TMS vs. ECT: Which is Better For Treatment Resistant Depression?

For some people, talk therapy and standard antidepressants work well to control depression symptoms. However, 21.4%-44.2% of depression sufferers have treatment-resistant depression (TRD), meaning they don’t respond to medications and therapy — but there’s still hope.

Most depression treatments attempt to increase your brain’s neurotransmitters, receptors, and brain-derived neurotrophic factors — a protein that promotes connections between your brain’s nerve cells. Ever-emerging research reveals new approaches to accomplish this. 

Before treating you, Dr. Giles conducts a thorough psychiatric consultation to confirm a depression diagnosis, determines the severity and scope of your symptoms, and assesses the treatments you’ve undergone. 

When warranted for TRD, Dr. Giles may recommend several approaches, including lifestyle changes, functional medicine, pharmacogenetic testing, Spravato®, IV ketamine therapy, or TMS. 

Transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) target your prefrontal cortex, the part of your brain where depression causes poor connections (synapses), aiming to normalize the activity and relieve your symptoms.

Dr. Karen Giles specializes in treating TRD with the most advanced technology and innovative approaches at Breakthru Psychiatric Solutions in Sandy Springs, Georgia. Here, she explains the differences between TMS and ECT.

TMS vs. ECT: Which is better?

Because our patients often ask about the difference between TMS and ECT, Dr. Giles has outlined the key aspects of each.


Transcranial magnetic stimulation uses a magnetic field to trigger changes. Dr. Giles places a small magnetic coil adjacent to over your head, and the device delivers rapid energy pulses — about 3,000 per session — with no anesthesia necessary.

Dr. Giles offers TMS because it’s gentler, less extreme, and just as effective as ECT. Here’s what TMS offers: 

  • Increases your neurotransmitters
  • Performed in-office
  • Uses gentle magnetic pulses
  • Feels like a light tapping
  • Lasts about 18 minutes
  • Requires five daily treatments per week for six weeks 
  • Side effects are minimal and may include a mild, temporary headache
  • Highly effective
  • Safe to drive yourself home and go about your daily routine
  • Most preferred treatment compared to ECT
  • Treats TRD, anxiety disorders, and obsessive-compulsive disorder

As TMS research continues, more conditions may benefit from this innovative treatment, including alcohol use disorder, which is currently undergoing studies. 


Electroconvulsive therapy occurs while you’re under general anesthesia. A psychiatrist attaches electrodes to your scalp and delivers controlled electrical currents to your brain, which triggers brief therapeutic seizures that impact your neurotransmitters. 

ECT typically costs more than TMS and offers the following:

  • Incites an electrically induced seizure to stimulate the brain
  • Performed in an operating room
  • Uses electrical currents
  • Pain-free due to general anesthesia
  • Lasts about an hour, including treatment and recovery
  • Requires 2-3 weekly sessions for 6-12 weeks
  • Side effects include headaches, muscle pain, confusion, disorientation, nausea, and short- and long-term memory loss
  • Highly effective
  • Requires someone to drive you home and stay with you for 24 hours
  • In the state of Georgia, you can’t drive for the entire 6 - 12 weeks of treatment
  • Treats TRD, major depressive disorder with psychosis, and catatonia

Although effective, ECT has serious side effects that may alter your cognitive abilities. Some people also lose the ability to form new memories for a few weeks or months after ECT treatments. Studies show that TMS and ECT are both effective treatments for TRD with nearly equal efficacy ratings, with ECT taking a slight lead. However, TMS benefits have been shown to last longer than ECT benefits. Overall, more patients prefer TMS. 

To schedule a consultation with Dr. Giles and learn how TMS can address your treatment-resistant depression, contact us online or by phone.