Psychology › Therapy & treatment › Psychiatric medicine: drugs and brain treatments
Brain stimulation: ECT and TMS
ECT 1938; TMS FDA-cleared 2008· Therapy or method
Well replicatedStrong, repeated evidence.
Treatments that stimulate the brain directly: electroconvulsive therapy (ECT) uses a controlled seizure; TMS uses magnetic pulses.
See it on the Psychology map →What it says
Italians Ugo Cerletti and Lucio Bini gave the first ECT in Rome in 1938. Today it is done under general anesthesia with a muscle relaxant, typically 6 to 12 sessions over a few weeks. It is the most effective treatment for severe depression, helping roughly 60 to 80 percent, often when nothing else has; the main side effect is memory loss around the treatment period. TMS, FDA-cleared in 2008, needs no anesthesia but works less strongly.
Why it matters
ECT saves lives in severe, suicidal or catatonic depression, yet is underused because of stigma from early unanesthetized use and films like One Flew Over the Cuckoo's Nest (1975).
The evidence
Decades of trials, including British studies in the 1970s and 80s comparing real ECT with sham anesthesia-only sessions, and TMS trials using sham coils.
Open questions
Why a seizure relieves depression is unknown; theories include resetting brain networks and new neuron growth. The extent of lasting memory loss is debated.
Connections (2)
▸Brain stimulation: ECT and TMS is the device-based branch of Psychiatric medicine: drugs and brain treatmentsWell replicated
The connection
Alongside drugs, psychiatry uses devices that act on the brain directly: ECT, which triggers a brief seizure; TMS, which uses magnetic pulses; and vagus nerve and deep brain stimulation. These are typically used when medication and therapy have not worked.
Who showed it and when
ECT in Rome, 1938; vagus nerve stimulation approved for depression in 2005; TMS cleared in 2008; deep brain stimulation for severe OCD allowed under a special exemption in 2009.
The evidence
Sham-controlled trials support ECT and TMS for depression; evidence for vagus nerve and deep brain stimulation is weaker.
Open questions
Newer approaches, such as rapid, brain-scan-guided TMS courses cleared in 2022, show promise, but long-term results and how they work are still unclear.
▸Brain stimulation: ECT and TMS treat severe, treatment-resistant Depression and mood disordersWell replicated
The connection
ECT is the most effective treatment for severe or treatment-resistant depression, including depression with psychosis or high suicide risk, often working within weeks. TMS helps roughly a third to half of patients whom medications failed. Both are usually offered after other treatments.
Who showed it and when
ECT has been used for depression since the 1940s; Mark George and others tested TMS in the 1990s, and a 2007 trial led to FDA clearance in 2008.
The evidence
Controlled trials and meta-analyses, including the UK ECT Review Group's in 2003, show ECT beats sham ECT and medication for severe depression.
Open questions
Relapse after ECT is common without follow-up treatment, and a 2023 trial found ketamine about as effective for some patients without psychosis.