A Comparison of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Nonpsychotic Treatment-Resistant Depression: A Real-World Study in Taiwan
J ECT. 2025 Nov 25. doi: 10.1097/YCT.0000000000001205. Online ahead of print.
ABSTRACT
OBJECTIVES: The goal of this study was to compare the response/remission rates, time to response/remission, and common side effects between treatment-resistant depression (TRD) patients receiving the electroconvulsive therapy (ECT) and those receiving standard repetitive transcranial magnetic stimulation (standard rTMS).
METHODS: TRD patients who received ECT or standard rTMS between March 2014 and August 2023 were included. Only patients receiving 20 standard rTMS treatments or at least 6 ECT treatments entered the analysis. Six-item Hamilton Depression Rating Scale (HAMD-6) and common side effects were routinely assessed during the treatment period. Response and remission were defined as a HAMD-6 ≥50% reduction and a HAMD-6 ≤4, respectively. Survival analysis was used to compare the time to response/remission between the two groups.
RESULTS: Compared with the standard rTMS group (N = 96), the ECT group (N = 92) showed a significantly higher treatment completion rate. For completers, the ECT group (N = 74) had significantly higher response rate/remission rate and shorter time to response/remission than the standard rTMS group (N = 63). No patients treated with standard rTMS experienced subjective memory impairment or nausea/vomiting, while 82.4% and 32.4% of patients receiving ECT experienced subjective memory impairment and nausea/vomiting, respectively. The ECT group experienced significantly higher rates of headache and muscle pain than the standard rTMS group.
CONCLUSIONS: Compared with the standard rTMS group, the ECT group was more likely to have a higher completion rate, have higher response/remission rates, a short time to response/remission, and experience more side effects during the treatment period.
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