TMS vs ECT: what each is for
TMS (transcranial magnetic stimulation) is 36 awake sessions over 6 to 9 weeks, with remission around 30 to 40 percent and insured cost $20 to $90 per session. ECT (electroconvulsive therapy) uses anesthesia for 6 to 12 sessions over 2 to 4 weeks, with remission around 50 to 70 percent in severe depression. Hospital cost share is $150 to $900 per session.
Updated · Checked by the Covered Mind editorial team against cited sources
TMS is an office procedure with mild side effects; ECT is a hospital procedure under anesthesia with the highest remission rates for severe depression. When each is the right tool.
Key facts
- Last checked:
- Sources listed: 2
- Reading time: About 2 minutes
- TMS course: 36 sessions over 6 to 9 weeks
- TMS remission: Roughly 30 to 40 percent
- ECT course: 6 to 12 sessions over 2 to 4 weeks
- ECT cost share: $150 to $900 (hospital cost share)
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 2 |
| Reading time | About 2 minutes |
| TMS course | 36 sessions over 6 to 9 weeks |
| TMS remission | Roughly 30 to 40 percent |
| ECT course | 6 to 12 sessions over 2 to 4 weeks |
| ECT cost share | $150 to $900 (hospital cost share) |
The short version
TMS is for moderate to severe depression after medication failure, in people who can attend daily outpatient sessions. ECT is for severe, psychotic, catatonic or life-threatening depression, or when everything else has failed. ECT works faster and more often; TMS has far fewer side effects. Check TMS and ECT coverage in the coverage checker and read TMS coverage by insurer. For the session schedule and common questions in one place, see the TMS overview. Read TMS for depression.
Side by side
| TMS | ECT | |
|---|---|---|
| Setting | Office, awake | Hospital or surgery center, general anesthesia |
| Course | 36 sessions over 6 to 9 weeks | 6 to 12 sessions over 2 to 4 weeks |
| Remission rate | Roughly 30 to 40 percent | Roughly 50 to 70 percent in severe depression |
| Cognitive effects | None | Memory loss around treatment, usually recovering over weeks to months |
| Other side effects | Headache, scalp discomfort | Headache, muscle aches, confusion after sessions |
| Driving | Yes | Not during the course |
| Coverage | Most plans with prior authorization | Broadly covered |
| Insured cost per session | $20 to $90 | $150 to $900 (hospital cost share) |
When is ECT the right choice?
Severe depression with psychosis, catatonia, refusal to eat or drink, or imminent suicide risk; depression in pregnancy when medications are risky; or failure of multiple medications and TMS. ECT remains the most effective treatment in psychiatry for these situations.
When is TMS the right choice?
Depression that has not responded to two or more medications in someone who is functioning well enough to come in daily and for whom memory effects are unacceptable.
Read TMS for treatment-resistant depression.
What order do clinicians use?
Typically medication trials, then TMS or Spravato (esketamine), then ECT. Severity can move ECT to the front of the line. Ask your psychiatrist directly where you fall.
See the ECT overview, the TMS overview, and TMS: the complete guide.
Related reading: Treatment-resistant depression: what the criteria actually mean and Side effects and safety: Spravato, ketamine and TMS.
Sources
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "TMS vs ECT: what each is for." https://www.coveredmind.com/compare/tms-vs-ect. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.