Patients researching options for treatment-resistant depression may encounter both TMS and ECT. Both are evidence-supported brain stimulation treatments, but they differ in how they are delivered, their side effect profiles, and the clinical situations in which they may be considered. At The Mind Grove TMS Center in Colorado Springs, we offer standard rTMS, iTBS, and Accelerated TMS using MagVenture technology. We do not assume that TMS and ECT are interchangeable or that one treatment always comes before the other. The right approach depends on the individual clinical picture.
What TMS Is
Transcranial magnetic stimulation, or TMS, is a non-invasive treatment that uses magnetic pulses delivered through a coil positioned against the scalp. At The Mind Grove TMS Center, we offer standard rTMS, iTBS, and Accelerated TMS using MagVenture technology. Patients remain seated and awake during treatment, and TMS does not require anesthesia or sedation. Most patients can resume their usual activities afterward, although individual experiences vary (Trapp et al., 2025).
Common TMS side effects include headache and scalp or stimulation-site discomfort, while serious adverse effects such as seizure are rare (Trapp et al., 2025). TMS has FDA-cleared depression-related indications, including a separate MagVenture clearance as an adjunct treatment for MDD in adolescents ages 15–21 (U.S. Food and Drug Administration, 2025). Insurance coverage depends on the diagnosis, insurance payer, and medical-necessity requirements.
What Is ECT?
Electroconvulsive therapy, or ECT, is a psychiatric treatment performed under general anesthesia in which a controlled electrical current produces a brief seizure (Mayo Clinic, 2024). ECT has a substantial evidence base and may be considered for severe depression, including situations in which a rapid clinical response is especially important.
ECT requires anesthesia, medical monitoring, and a recovery period after each treatment. In the United States, treatments are generally given two to three times per week for several weeks, although the exact course depends on the patient’s condition and response. ECT may be provided during a hospital stay or in an outpatient setting, and patients receive specific restrictions about driving and other activities after treatment (Mayo Clinic, 2024).
Cognitive side effects, including memory effects, are an important consideration with ECT. Patients may experience confusion or difficulty remembering events around the treatment period, and autobiographical memory can also be affected. A 2026 systematic review and meta-analysis found greater autobiographical memory loss after ECT than in comparison groups, with effects varying by electrode placement and remaining evident at longer follow-up (Mathiassen et al., 2026). These risks should be discussed as part of the individualized decision about whether ECT is appropriate.
The Key Differences
The procedures differ in several important ways. TMS does not require anesthesia or an induced seizure, and patients remain awake throughout treatment. Most patients can resume their usual activities after a TMS appointment. ECT requires general anesthesia and a controlled seizure, followed by monitoring during recovery and temporary restrictions on activities such as driving (Trapp et al., 2025; Mayo Clinic, 2024).
The side effect profiles also differ. Common TMS effects include headache and scalp or stimulation-site discomfort, while serious adverse effects are rare (Trapp et al., 2025). ECT can cause confusion, physical side effects, and memory problems, including autobiographical memory loss in some patients (Mathiassen et al., 2026). We do not reduce that comparison to one treatment being categorically safer than the other; the risks and benefits need to be considered in the context of the individual patient.
In terms of setting, TMS is typically delivered in an outpatient clinic. ECT is more commonly administered in a hospital, reflecting both the anesthesia requirement and the monitoring needed following each session.
When isTMS or ECT Recommended for Treatment of Depression
Both TMS and ECT are considered effective for treatment resistant depression, and both are considered forms of neuromodulation. However, neither are the only options patients have for treatment resistant depression. The appropriate treatment for an individual depends on many factors, including co-occuring medical and mental health diagnoses, symptom severity, safety considerations, current and previously trialed treatments, and the patient’s treatment goals.
ECT may be especially important in severe presentations where a rapid response is clinically necessary, including severe depression with suicidality, psychotic symptoms, or catatonia (Mayo Clinic, 2024). TMS may be appropriate for qualifying patients when outpatient, daily treatments are feasible and suit the clinical situation. Which Treatment Is Right for You
The right treatment depends on your individual clinical picture. We consider diagnosis, symptom severity and urgency, prior treatment, current medications, medical and safety considerations, and the patient’s priorities before recommending TMS.If another treatment or level of care is more appropriate for your presentation, that will also be part of the clinical discussion.
FAQ
Is TMS safer than ECT?
TMS and ECT have different risks, and neither should be described as categorically safer in every clinical situation. TMS does not require anesthesia or an induced seizure, and its most common side effects include headache and scalp discomfort. ECT requires anesthesia and a controlled seizure and can cause confusion and memory effects. For some severe or urgent presentations, ECT may still be the more appropriate treatment. The decision depends on the individual patient’s risks, symptoms, treatment history, and clinical needs.
Does TMS work as well as ECT?
Both TMS and ECT have evidence supporting their use in treatment-resistant depression. A 2025 network meta-analysis found that both ECT and rTMS produced higher response rates than placebo or sham treatment, with ECT showing the largest response estimate among the treatments studied (Saelens et al., 2025). That does not make ECT the right choice for every patient. Severity, urgency, risks, treatment history, logistics, and patient preferences all matter when comparing the options.
Can I do TMS instead of ECT if my doctor recommended ECT?
That is a conversation to have with your treating provider. TMS and ECT are not always interchangeable, and there are clinical scenarios in which ECT is the more appropriate choice. If you have questions about whether TMS could be an appropriate alternative in your situation, that conversation belongs in a clinical context where your full history can be reviewed. We are happy to be part of that conversation through a consultation at The Mind Grove TMS Center.
Does insurance cover both TMS and ECT?
Coverage varies by payer and medical-necessity criteria. At The Mind Grove TMS Center, we accept insurance for qualifying FDA-cleared TMS indications, subject to the requirements of each plan. Colorado Medicaid does not currently cover TMS. ECT coverage is determined separately, so patients considering ECT should review benefits and requirements with their insurer and the provider offering that treatment.
Is TMS available for adolescents?
Yes. MagVenture TMS Therapy is FDA-cleared as an adjunct treatment for MDD in adolescents ages 15–21 (U.S. Food and Drug Administration, 2025). Dr. Megan Bowers, MD, PhD, is dual board-certified in Child and Adolescent Psychiatry and Adult Psychiatry, and that specialized training informs how we evaluate and treat adolescent patients. Whether ECT is appropriate for an adolescent is a separate clinical decision that requires individualized specialist evaluation.
Key Takeaways
TMS and ECT are both evidence-supported brain stimulation treatments, but they differ in procedure, side effect profile, treatment setting, and clinical considerations.
TMS does not require anesthesia or an induced seizure, and most patients can resume their usual activities after treatment.
ECT requires general anesthesia and a controlled seizure; confusion and memory effects, including autobiographical memory loss, are important risks to discuss before treatment.
TMS and ECT are both effective options for treatment resistant depression. Severity, urgency, prior treatment, medical factors, and patient preferences all influence which option may be most appropriate.
At The Mind Grove TMS Center, Dr. Bowers evaluates whether TMS is appropriate based on the individual patient’s diagnosis, treatment history, current medications, symptoms, and safety considerations.
If you are weighing brain stimulation options, we can evaluate whether TMS is appropriate for your individual clinical situation. Dr. Bowers reviews your diagnosis, treatment history, current medications, symptom severity, safety considerations, and current care plan before making a recommendation. Contact The Mind Grove TMS Center in Colorado Springs to schedule a consultation.
References
Mathiassen, A. B., Semkovska, M., Lundsgaard, C. C., Gbyl, K., & Videbech, P. (2026). Autobiographical memory after electroconvulsive therapy: Systematic review and meta-analysis. The British Journal of Psychiatry, 228(3), 263–273.https://pubmed.ncbi.nlm.nih.gov/40357797/
Mayo Clinic. (2024). Electroconvulsive therapy (ECT).https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894
Saelens, J., Gramser, A., Watzal, V., Zarate, C. A., Jr., Lanzenberger, R., & Kraus, C. (2025). Relative effectiveness of antidepressant treatments in treatment-resistant depression: A systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology, 50(6), 913–919.https://pubmed.ncbi.nlm.nih.gov/39739012/
Trapp, N. T., Purgianto, A., Taylor, J. J., Singh, M. K., Oberman, L. M., Mickey, B. J., Youssef, N. A., Solzbacher, D., Zebley, B., Cabrera, L. Y., Conroy, S., Cristancho, M., Richards, J. R., Flood, M. J., Barbour, T., Blumberger, D. M., Taylor, S. F., Feifel, D., Reti, I. M., McClintock, S. M., Lisanby, S. H., & Husain, M. M. (2025). Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clinical Neurophysiology, 170, 206–233.https://pubmed.ncbi.nlm.nih.gov/39756350/
U.S. Food and Drug Administration. (2025). MagVenture TMS Therapy System (K251125).https://www.accessdata.fda.gov/cdrh_docs/pdf25/K251125.pdf
Medical Disclaimer
The information in this blog is provided for educational purposes only and does not constitute medical advice. TMS therapy should only be pursued under the supervision of a licensed medical or psychiatric provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.