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Updated: Aug 18, 2026
MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Comparative Efficacies of Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS) in
Abdullahi Abdulwahab Yakubu1, Summayyah Muhammad Bashar1, Audu Ishaq Aveka1
1Department of Psychiatry, Ahmadu Bello University, Zaria, Nigeria.
Background:
Treatment-resistant depression (TRD) poses significant challenges globally, particularly in low-resource settings. While electroconvulsive therapy (ECT) remains the standard for TRD, repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive alternative. This study compared short- and long-term efficacy and safety of ECT versus rTMS among Nigerian patients with TRD.
Methodology:
In a randomized, rater-blinded trial, 40 adults with TRD received either ECT (n=20; bilateral, twice weekly for 3 weeks) or high-frequency rTMS (n=20; left dorsolateral prefrontal cortex, 3000 pulses/session, 5 sessions/week for 6 weeks). Depression severity (HAM-D) was assessed at baseline, weeks 2, 4, 6, and at 6 and 12 months.
Results:
Both interventions significantly reduced HAM-D scores (p<0.001). ECT showed faster early improvement (Week 4: ECT=10.30±2.84, rTMS=12.25±2.99; p<0.001), with comparable outcomes at Week 6 (ECT=4.30±2.23, rTMS=4.40±2.35; p=0.89). However, rTMS demonstrated superior long-term control at 6 months (4.05±2.11 vs. 6.60±2.97; p<0.001) and 12 months (5.25±2.89 vs. 10.55±3.45; p<0.001). Remission rates at 12 months were 65% for rTMS versus 20% for ECT. Adverse events, particularly cognitive impairment, were more frequent with ECT (60% vs. 0%; p<0.001).
Conclusion:
While ECT provides faster acute symptom relief, rTMS offers superior sustained benefits with fewer adverse effects, suggesting its potential as a first-line neurostimulation for TRD in resource-constrained settings. Larger studies with cost-effectiveness analyses are warranted.
