Repetitive transcranial magnetic stimulation and electroconvulsive therapy: complementary or competitive therapeutic...

To examine issues pertaining to the potential clinical roles of repetitive transcranial magnetic stimulation (rTMS) and the relationship of these to the use of electroconvulsive therapy (ECT).

A review of studies was carried out comparing the use of rTMS and ECT, with consideration of issues relating to the populations in which rTMS may be applied.

There have been a number of randomized comparisons of rTMS and ECT. There are limitations with these studies, but in general they indicate that in non-psychotic patients rTMS appears to have a similar rate of response to ECT and certainly seems to have meaningful clinical effects. There are a number of clinical subpopulations in whom rTMS, but not ECT, is suitable, and assessment of the effectiveness of TMS in these populations is required.

Repetitive TMS and ECT are likely to prove to be complementary clinical tools and the introduction of clinical programmes with rTMS will enhance patient options rather than replace the use of ECT.