Role of Electroconvulsive Therapy and Transcranial Magnetic Stimulation in Treatment-Resistant Depression

Abstract

Electroconvulsive therapy (ECT) is one of the oldest known psychiatric treatments in modern times. It preceded modern pharmacotherapy for mood disorders and continues to play a major role in treatment-resistant depression (TRD). Its proven efficacy has been the inspiration behind the continued advancements in the field of neurostimulation. Electroconvulsive therapy, vagus nerve stimulation, and repetitive transcranial magnetic stimulation (rTMS), are currently approved by the US Food and Drug Administration (FDA) as neurostimulation modalities for TRD. Other modalities of neurostimulation such as transcranial direct current stimulation, deep brain stimulation, and magnetic seizure therapy have been studied and used, but are not yet FDA approved. In this article, we will focus on two modalities that are widely used and available to patients: ECT and rTMS. While both treatments are recommended for TRD, either alone or in conjunction with other treatments, they vary widely in their safety profile and treatment protocol, which impacts both patient selection and public perception. [ Psychiatr Ann . 2024;54(6):e164–e169.]