A Comparison of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Nonpsychotic Treatment-Resistant Depression: A Real-World Study in Taiwan.

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.