First-line treatments for major depressive disorder (MDD) are therapy and antidepressants. Therapy works by identifying negative thought patterns and triggers for your depression. It can also help you make lifestyle modifications to avoid the pitfalls of depression.
Antidepressants help to address your brain’s chemical imbalance or cause for depression in the first place, but they can take months to have an effect, and not everyone responds well to every drug. A combination is typically more effective in attacking your depression from multiple angles.
There are many classes of antidepressants, each with its various systemic side effects. If you were not responding to medication after multiple drug trials or were increasingly at risk to yourself or others, the next option was electroconvulsive therapy (ECT).
What is ECT?
ECT has been the long-standing last resort treatment for depression and other psychiatric disorders, dating back to the late 1930s when it was called shock therapy. While the medical field has made many advances to make it safer and more effective, it’s still performed in a hospital outpatient setting under anesthesia.
You will be in a surgical suite where a medical professional will administer short electrical shocks. These stimulate your brain to induce minor therapeutic seizures without any muscle movement. The goal is that the electric activity will stimulate your brain to return to typical function, improving both your mood and mental state.
After treatment, you will need to recover on-site for some time. You can experience memory loss, and you will feel groggy and fatigued. You will need someone to bring you to and from your procedure since you cannot drive or do any concentration-heavy tasks.
Pros and Cons of ECT
ECT is highly effective for treating medication-resistant depression, giving patients their life back after no other depression treatment has worked. However, treatment takes an entire day, and you often need a day or two afterward to recover. It’s invasive, requiring IVs, fluids, and anesthesia. You can encounter:
- Muscle Aches
- Jaw Pain
- Feeling Dizzy or Nauseous
- Permanent Memory Loss
- Impaired Autobiographical Memory Retrieval for up to Three Months
What is TMS?
Newer to the treatment table, transcranial magnetic stimulation (TMS) harnesses magnetic fields that you would find in an MRI to stimulate specific areas of your brain responsible for your mood and emotions. A clinician will place a small electromagnetic probe on your scalp, and you can watch TV, read, or listen to music while you receive your treatment. The most common side effect is a slight headache or scalp discomfort from the probe placement. Both can be covered with over-the-counter pain medication and resolve within a few days.
Pros and Cons of TMS for MDD
TMS is a much gentler treatment option. You will be fully awake, relaxing in a doctor’s office while you get your treatment. The treatment course is longer, but the daily treatment time is relatively short, which you can complete on your lunch break before returning to work. No cognitive or systemic side effects will keep you from your daily activities. TMS is also as effective as ECT when treating non-psychotic depression.
The Cost Comparison
Before bringing insurance into the equation, TMS is roughly half the cost of ECT because TMS requires less staff and monitoring, and you can have it in an outpatient office setting. Because ECT is done in an operating room and involves nurse monitoring and an anesthesiologist, it’s much more expensive.
Private insurance or Medicare/Medicaid will cover ECT and TMS, depending on your plan. However, your out-of-pocket costs and copays are significantly higher with ECT because of the nature of the treatment. You will also receive up to 12 sessions of ECT over six weeks, making it challenging to maintain a job or work during that time.
ECT and TMS are Effective MDD Treatments
Both TMS and ECT are popular depression treatments because of their effectiveness. They will alter your brain’s neurotransmitter levels and receptors, so you will have improved brain chemistry to combat your depression. ECT does have higher published efficacy rates, but this could be because of the length of time it has been a treatment option. It is also considered a last resort despite the higher efficacy because of the risks and side effects. TMS is the newer and up-and-coming treatment option with very few reported adverse effects.
In addition to standard TMS, accelerated TMS will get you even faster results. Find out if it’s right for you here. Don’t wait until you’re out of options, looking for any way out of your suffering. Speak to your doctor today about depression treatments. You always have options as new therapies, medications, and brain stimulation techniques are being developed and perfected as you read this.