Some considerations in choosing electroconvulsive therapy versus transcranial magnetic stimulation for depression

Transcranial magnetic stimulation (TMS) has recently been approved by the Food and Drug Administration for treatment of depression refractory to at least 1 antidepressant medication. Clinical psychiatrists as well as patients are likely to inquire about TMS as a therapeutic option for the depressed patient. In particular, as TMS is a procedure that has at least some superficial similarities to electroconvulsive therapy (ECT), there will be interest in using TMS as a possible alternative to ECT. On the other hand, ECT has been in use for many decades and has a well-established track record of being the most effective treatment for depression. In this article, the author reviews the efficacy, adverse effect profile, cost, and inconvenience issues for both TMS and ECT and outlines some considerations for current clinical decision making regarding the choice between these 2 modalities.