TMS VS. Other Depression Treatments

In treating the symptoms of Major Depression, antidepressant medications and psychotherapy are considered first-line treatments. However, these therapies do not work for all patients, and sometimes they do not yield satisfactory results. This is where TMS Therapy comes in. TMS Therapy is specifically cleared by the FDA as treatment for Major Depression Disorder and is often prescribed when medicinal treatments do not yield satisfactory results.

If you are interested in exploring more about this topic (including TMS versus treatments for other conditions) we also have a place on the community forum where you can expand on our section through discussions with other community members.

** On this page, we’ll only be focusing on TMS as a treatment for depression and not TMS versus treatments for other conditions. There are many different options for treating depression, but we’ll focus on the differences between medicinal treatments, ECT, and TMS.

TMS and Medication

Antidepressants have numerous side effects such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems; TMS Therapy has very few to no side effects.
Antidepressants are systemic, meaning that the medicine enters the body and blood stream; TMS Therapy is non-systemic.
TMS Therapy is usually prescribed when antidepressants fail.

Speaking very specifically, TMS Therapy was cleared by the FDA in 2008 as an appropriate treatment option for adult patients with Major Depressive Disorder who have failed to achieve satisfactory improvement from at least one prior antidepressant medication at or above the adequately effective dose over an adequate duration.

It is important to note that in clinical trials that studied the effectiveness of TMS Therapy, half of the patients had been treated with at least four medication treatment attempts, one of which was at an adequate dose and duration. TMS Therapy’s effectiveness has not been established in patients who have tried and failed to receive benefit from at least two or more prior antidepressant medications at minimal dose and duration; nor has it has been studied in patients without prior antidepressant medication treatment.

Most doctors and psychiatrists agree that TMS Therapy is a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications or do not wish to take them. Many patients suffer intolerable side effects to commonly used antidepressants, such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems. TMS Therapy is non-systemic, so nothing enters your body or your bloodstream. That means that TMS Therapy is free of side effects typically associated with these medications. This also means that patients can immediately return to regular activity after TMS sessions.

Although numerous antidepressant medications and other treatments are available, many patients suffer multiple depressive episodes that are not well controlled with existing therapies. Some patients who have been treated with multiple anti-depressants are still severely depressed. In these cases, TMS Therapy might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy.

During TMS Therapy, you should continue to work with the physicians who manage your medications. Patients may continue to take antidepressant medication while receiving TMS therapy if recommended by their physicians.

TMS and ECT

ECT requires anesthesia whereas TMS does not
ECT applies electrical energy, while TMS uses magnetic energy
ECT affects the whole brain whereas TMS affects only the prefrontal cortex
TMS Therapy is a non-invasive procedure
TMS Therapy does not require anesthesia
ECT is designed in such a way that it produces a seizure, TMS does not
ECT causes short term memory loss; there is no reported memory loss with TMS

Some patients who have been treated with multiple anti-depressants are still severely depressed. In such cases, “treatment-resistant” patients traditionally receive Electroconvulsive Therapy, or ECT.

While both TMS Therapy and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability. Both are designed to treat depression through the application of energy into the brain, but the similarities quickly dissolve after that.

While ECT can be highly effective, it is also highly invasive, and some patients suffer unwanted side effects. These include memory loss, seizures, hospitalization, and headaches. On the other hand, TMS Therapy has very little to no side effects and is not invasive in any way.

Perhaps the most impacting difference is the type of energy that each procedure applies. ECT applies an electric impulse while TMS applies a magnetic impulse. Magnetic stimulation has the major advantage over electrical stimulation of being able to stimulate the human brain and deep peripheral nerves without causing pain. The skull is very insulated against electrical currents, so ECT requires that much more power. However, the skull presents no barrier to TMS and the low-frequency magnetic fields pass through without decreasing effect. This means that the currents induced by magnetic stimulation are not as dense as that which occurs for electrical stimulation.

As a result, TMS Therapy is reported as being far more comfortable and produces far fewer side effects than ECT. Magnetic stimulation is essentially painless because the induced current does not pass through the skin, where most of the pain nerve endings are located.

The other note of distinction between TMS Therapy and ECT is the invasiveness of ECT. ECT intentionally causes a seizure to treat depression. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. TMS is an outpatient procedure performed at the supervising doctor’s office or clinic. Patients take no sedative or anesthesia and are awake and alert the entire time. After a TMS session, patients can immediately resume daily activities and can even drive themselves home or to work immediately following treatment.

Side effects from TMS Therapy are rare and usually include only a mild headache at the area of treatment or mild scalp irritation at the site of treatment. Side effects from ECT can include seizures, severe headaches, and short-term memory loss which may persist indefinitely in some patients. Because of the side effects associated with ECT, a significant amount of caregiver support is required. However, in over 10,000 active treatments with TMS Therapy, no seizures were observed. TMS Therapy was also shown to have no negative effects on memory function in these studies.

It should be noted that in cases where severe depression remains after TMS Therapy, patients have been recommended Electroconvulsive Therapy, or ECT. Like any treatment option, you and your TMS prescribing psychiatrist or doctor should work together to find the most appropriate treatment option for you.

TMS VS. Other Depression Treatments

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