TMS vs ECT: what each is for

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. See the coverage hub, the TMS hub, and the coverage checker.

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 | 0 to 0 | 50 to 00 (hospital cost share) |

When ECT is 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 TMS is 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.

The order clinicians use

Typically medication trials, then TMS or Spravato, then ECT. Severity can move ECT to the front of the line. Ask your psychiatrist directly where you fall.

See ECT programs by state and TMS providers by state.