Currently, depression is the most prevalent mental disorder globally, and typically, medication and non-invasive therapies are the most effective treatment options. Nevertheless, for some individuals, especially those with severe clinical depression, these treatments may not work, leading to the exploration of alternative options such as Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT), which differ significantly from one another.
Transcranial Magnetic Stimulation (TMS)
TMS may not be suitable for everyone, and many people are unfamiliar with it. TMS was first developed in the 1980s, and a modified version had been in use by neurologists before then. The procedure involves the non-invasive application of brief, repeated magnetic fields in alternating directions near the head, specifically targeting nerve cells in the cerebral cortex.
In cases of clinical depression, there is an increase in activity in the right frontal lobe, which is responsible for emotions such as anxiety and avoidance behaviors. Conversely, the left frontal lobe, which governs feelings of optimism and approach behaviors, experiences a reduction in activity. TMS is used to treat depression by either increasing activity through a high-frequency pulse to the left frontal lobe or decreasing activity by administering a low-frequency pulse to the right frontal lobe. This treatment is generally considered only when traditional antidepressants have not shown significant improvement.
Is TMS treatment ongoing?
To put it briefly, TMS treatment has an initial effect that lasts for around six months. After that, patients usually undergo shorter top-up TMS treatments every few months. Each session typically takes approximately 30 minutes, and patients are expected to undergo three to five treatments per week. Although there is no fixed number of treatments that a person may need, typically a patient would receive up to 30 treatments.
TMS Efficacy and Side Effects
In simple terms, TMS stimulates brain chemistry, while medication alters it. It is important to note that while these two methods differ, they can often be beneficial when used in combination. Medication can act as an adjunct to TMS and manage symptoms once the TMS procedure is completed.
Some common side effects of TMS include mild headaches, skin discomfort from the electromagnetic pad, tingling, spasms, or twitching of facial muscles, and feeling light-headed or dizzy. These side effects typically disappear after a few sessions for most individuals.
However, some rare side effects of TMS include the onset of seizures, mania (usually in people with diagnosed bipolar disorder), and hearing loss (often due to inadequate ear protection during treatment).
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is a contemporary psychiatric treatment that involves passing direct currents through the cerebral cortex to induce a brief seizure, with the goal of alleviating symptoms in individuals with treatment-resistant mental illnesses. Specifically, ECT involves administering a brief electrical stimulation to the brain while the patient is under anesthesia. This stimulation results in a controlled seizure that can help alleviate symptoms of various mental illnesses such as severe depression, bipolar disorder, and schizophrenia. Is ECT Treatment Ongoing?
A single session of ECT can take up to 60 minutes. Each ECT treatment is usually administered two to three times a week for up to 12 treatments; however, the exact number will depend on the nature of the illness and the person's response to the treatment. ECT is typically reserved for cases where other treatments have failed, and it is usually administered in a hospital setting under the supervision of a qualified healthcare professional.
ECT Efficacy and Side Effects
Modern ECT is vastly different from the treatment depicted in Ken Kesey's novel One Flew Over the Cuckoo's Nest. Since the 1940s, ECT has been recognized as an effective treatment for severe mood disorders. Studies have shown that ECT can significantly improve treatment-resistant depression and reduce the likelihood of relapse in patients with mood disorders. In fact, follow-up studies have found that patients who receive ECT have a lower overall mortality rate compared to those receiving other treatments.
However, ECT does have potential side effects. Common side effects of ECT include confusion for several hours after treatment, short-term memory loss, nausea, headaches, jaw aches, and muscle aches. ECT can also place stress on the cardiovascular system, making it unsuitable for individuals with heart disease. Rare side effects may include adverse reactions to anesthesia, changes in heart rhythm, and lifelong heart issues. Additionally, 1 in 50,000 people may die from ECT treatment.
It's important to note that those undergoing an ECT program may experience a loss of independence since they are unable to drive, including between sessions.
TMS and ECT the same?
TMS and ECT are not the same. While TMS does not require anesthesia and does not induce a seizure, ECT involves passing an electrical current through the brain to trigger a short seizure. TMS uses magnetic impulses to stimulate specific parts of the brain and is generally associated with fewer side effects than ECT. While ECT is more effective than TMS in treating severe depression, it also has more significant side effects. Both treatments can be effective for conditions such as OCD, PTSD, anxiety, and depression, but ECT is a more controversial intervention. While there are still questions about the long-term benefits of TMS, ECT remains a widely debated therapeutic intervention in clinical practice.
The Bottom Line
In conclusion, both ECT and TMS are valuable treatment options for individuals with treatment-resistant mental illnesses. ECT has been shown to be highly effective in treating severe mood disorders, with a lower risk of relapse and overall mortality rate compared to other treatments. However, it comes with the risk of potential side effects, including memory loss and cardiovascular stress. TMS, on the other hand, offers a non-invasive and well-tolerated treatment option with minimal side effects. While more research is needed to fully understand its long-term effectiveness, TMS shows promise in treating a range of mental health conditions. Ultimately, the decision to use either ECT or TMS should be made in consultation with a mental health professional based on an individual's specific needs and circumstances.
Author Teresa Coffey
Resources
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