ECT more effective than rTMS for severe depression

[David Baxter]

ECT an effective treatment option for severe depression

Electroconvulsive therapy (ECT) appears more effective than repetitive transcranial magnetic stimulation (rTMS) for short-term treatment of severe depression. This finding is presented in the January 2007 issue of the American Journal of Psychiatry (AJP).

The researchers found that patients who received ECT and rTMS produced remission rates of 59 percent and 17 percent, respectively. Six months later, the patients' ratings of psychiatric symptoms remained lower in the ECT patients. The trial included 46 patients, 24 assigned to rTMS and 22 assigned to ECT.

At the end of treatment, scores on the Hamilton Depression Rating Scale had fallen by 58 percent in the ECT group and 22 percent in the rTMS group. The difference in scores between groups was statistically significant at the end of treatment but not at six months. However, differences did remain in self-rated mood measures and psychiatric symptoms overall.

All patients had been referred for ECT and continued to take their medications. rTMS was administered on a fixed schedule of 15 daily treatments but ECT continued until a response was evident. The ECT group reported fewer side effects after treatment, compared to the rTMS group. ECT can be associated with posttreatment memory problems, but the only difference in cognitive measures was a mild improvement in attention and orientation among patients who received ECT, compared with a decrease in the rTMS group.

ECT is helpful for people whose severe depression has not responded to other treatments. rTMS is nonconvulsive and requires no anesthesia, and initial randomized studies suggested that its effectiveness was similar to ECT. This study compared the two treatments under real-world conditions and over time. The authors point out that while the optimal administration of ECT has been determined over several decades, the most effective methods for rTMS are not yet known.

"ECT, despite its stigmatization, continues to be the most effective treatment available for depression resistant to usual drug and psychotherapies," stated AJP Editor in Chief Robert Freedman, M.D. "This study affirms that the newer magnetic stimulation method despite some initial promise is not as effective."

This study was supported by the Health Technology Assessment Programme of the National Institute for Health Research, the Guy's and St. Thomas's Charitable Foundation and a 2003 Ritter Independent Investigator Award from the National Alliance for Research on Schizophrenia and Depression.

Eranti S, Mogg A, Pluck G, Landau S, Purvis R, Brown RG, Howard R, Knapp M, Philpot M, Rabe-Hesketh S, Romeo R, Rothwell J, Edwards D, McLoughlin DM. A Randomized, Controlled Trial With 6-Month Follow-Up of Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy for Severe Depression. Am J Psychiatry 2007 164: 73-81 [Abstract]

[Daniel]

The ECT group reported fewer side effects after treatment, compared to the rTMS group.

Wow, that's something I would not have guessed.

[Misha]

I haven't had either treatment, but I'm surprised by the side effect thing too. From what I've seen people have very severe side effects with ECT, so I can't imagine what rTMS does.

[David Baxter]

Perhaps. It probably depends on several factors but more than once the only "side effect" I have seen following a brief course of ECT treatments is profound relief.

[Misha]

Perhaps. It probably depends on several factors but more than once the only "side effect" I have seen following a brief course of ECT treatments is profound relief.

Really? The mental health support group I attend 4 days a week is full of people who have significant memory loss after ECT treatments and significant cognitive impairment. For some it leaves completely, others stay in that "space" for a long time. Also, the physical drain is very short-term, but still a significant side effect...some of these people sleep for two days after a treatment, others can not find a balance of muscle relaxants and are debilitated in that way.
And you emphasize the word "brief," which is admittedly significant but from what I've seen these side effects start when treatment starts.
But again I haven't been there myself so I speak only from what I observe.

[David Baxter]

I'm not denying that there can be some adverse effects from ECT, sometimes enduring. I'm simply offering my observatioins that it's not always the case, at least for people for whom a short course yields the desired effects.

Some retrograde amnesia is inevitable. But as one client told me, even that was a relief because he was no longer obsessing about his perceived inadequacies and sins.

[Misha]

Good point, David. It is always a pleasant addition to my day when I hear of people finding the positive in what could be a negative situation.
My question: are the side effects of rTMS comparable/worse than ECT?

[Cat Dancer]

I'm not denying that there can be some adverse effects from ECT, sometimes enduring. I'm simply offering my observatioins that it's not always the case, at least for people for whom a short course yields the desired effects.

Some retrograde amnesia is inevitable. But as one client told me, even that was a relief because he was no longer obsessing about his perceived inadequacies and sins.

Could ECT be effective for OCD?

Do you have to go through all the different medications before you get to that point?

[foghlaim]

Do you have to go through all the different medications before you get to that point?

i've wondered this myself Janet...

i mean if ect works that well for most ppl that receive it... why wait till all other options have been tried.. whyis it the last option and not one of the first few tried?

[ThatLady]

ECT, while effective in recalcitrant cases, is a pretty serious intervention. It's a jolt of electricity to the brain! That's not to be taken lightly. It just makes sense to try something less invasive, like medications, before taking such a drastic step.

I'm really glad that ECT is available for those for whom medications just don't work. However, I'd hate to see it used as a first-line intervention.