Electroconvulsive Therapy (ECT) vs Transcranial Magnetic Stimulation (rTMS) vs Transcranial Direct Current Stimulation (tDCS)

Electroconvulsive Therapy (ECT)

With ECT, electrodes are placed on the patient’s scalp and a finely controlled electric current is applied while the patient is under general anaesthesia. The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It’s also very effective for patients who suffer from mania or several other mental illnesses. ECT is generally used when severe depression is unresponsive to other forms of treatment. It might be used when patients pose a severe threat to themselves or others and it is too dangerous to wait until medications take effect.

During ECT, a patient is given anaesthesia and muscle relaxant. Electrodes are placed on the patient’s scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and at times may be confused. The confusion typically lasts for only a short period of time.

ECT Pros

  • ECT has proven to be a very effective treatment for those with depression. Some ECT is better for the short-term treatment.
  • This treatment works much rapidly than any others, but consent must be given from the patient or a close relative.

ECT Cons

  • May need maintenance medications following ECTs, not a stand-alone mode of treatment.
  • Although these are much less common, memory loss is still a major concern. Memory loss rarely occurs after the first week of treatment, but the longer the treatment, the more severe the memory loss.
  • Should only be administered to those who have been unsuccessful in all other methods, and are at serious risk of suicide.

Transcranial Magnetic Stimulation (rTMS)

How TMS Works
TMS is a non-invasive, localized treatment conducted using a device that delivers rapidly pulsating and localized magnetic fields that activate a subset of nerve cells in the front part of the brain. While treatment is administered, patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the system generates highly concentrated magnetic field pulses. The treatment is delivered in a series of 20 minutes outpatient treatment, typically administered daily, (5 days per week) for 5 to 6 weeks.

TMS Pros

  • Does not require anaesthesia, non-invasive, well tolerated. An outpatient service and patient continues normal daily routines.
  • Current data demonstrates efficacy in patients who have struggled with medication.
  • May be good alternative for patients who have not responded to ECT in past.
  • No significant memory impairment.

TMS Cons

  • Mild discomfort / Headache (usually dissipates by end of first treatment).

Transcranial Direct Current Stimulation (tDCS)

Transcranial direct current stimulation (tDCS) is a neuro-modulatory technique that delivers low-intensity, direct current to cortical areas facilitating or inhibiting spontaneous neuronal activity. In the past ten years, tDCS physiological mechanisms of action have been intensively investigated giving support for the investigation of its applications in clinical neuropsychiatry and rehabilitation. Transcranial Direct Current Stimulation is a painless and non-invasive therapy that involves the delivery of mild electrical currents. In effect, these currents help stimulate certain areas of the brain.

How tDCS works
To begin the process of tDCS, two electrodes are placed over the head. Once the machine is fired up, constant low-intensity current (one to two mill amperes) is passed through the said electrodes for 10 to 20 minutes straight. The passing current then results in the modification neuronal activity. To prevent any adverse side effects, experts recommend allotting 48 hours before undergoing another round of tDCS.

tDCS Pros

  • tDCS is relatively painless and is non-invasive, so there is less downtime associated with pain and recovery.
  • tDCS is safe, effective with a low risk of adverse events
  • tDCS treatment can improve cognitive functions/speeding up learning processes.
  • tDCS can be helpful in treating Anxiety, Depression and regulating emotions.

tDCS Cons

  • Slight burning or mild tingling upon the application of electrical current.
  • Headache and nausea can also be expected, especially if the electrode is placed above the mastoid for the stimulation of the vestibular system.

Hopefully, continued research into and refinement of ECT, rTMS and tDCS will settle the subject. In the meantime, if you or a loved one is suffering from intractable mental illness, apart from medications, these three is something worth discussing with your Doctor/Psychiatrists/Mental health professionals.