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Electroconvulsive therapy versus transcranial magnetic stimulation for major depression: a review with recommendations for future research

  • Keith G. Rasmussen (a1)



To review the literature comparing electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for major depression.


Data from the six randomised, prospective studies were agglutinated into one data set. Special attention was given to the methods of both TMS and ECT as well as data pertaining to differential outcomes in subgroups such as psychotic depressives and the elderly.


There is a highly significant advantage for ECT in the prospective, randomised trials. The two non-randomised, retrospective comparative trials found the treatments to be equal in one study and superior for ECT in another. However, sample sizes are small in these studies, and both TMS and ECT may have been used suboptimally. Furthermore, the possibilities of differential efficacy of ECT or TMS for psychotic depressives or as a function of age have yet to be fully explored.


The data to date do not support the contention that TMS is equivalent in efficacy to ECT. It is recommended that a large-scale trial be undertaken using aggressive forms of both TMS and ECT with sample sizes sufficiently large to detect effects of moderating variables such as age and psychosis status.


Corresponding author

Keith G. Rasmussen, Mayo Clinic Department of Psychiatry and Psychology, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: 507-284-3789; Fax: 507-284-4158; E-mail:


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