Depression and Transcranial Magnetic Stimulation Outcomes With Prior ECT

Transcranial magnetic stimulation
Transcranial magnetic stimulation
Researchers found no compelling evidence that patients with a history of electroconvulsive therapy (ECT) have transcranial magnetic stimulation outcomes that are better or worse than ECT-naive patients.

For patients with major depressive disorder, prior history and response to electroconvulsive therapy (ECT) may not predict transcranial magnetic stimulation (TMS) treatment outcomes, according to results published in Neuromodulation.

The study included retrospective naturalistic TMS treatment data from participants with major depressive disorder (n=257). The researchers conducted 3 sets of analyses. The first looked at history of past exposure to ECT as a potential predictor of TMS outcomes measured by 2 self-support scales (n=71, ECT+ vs n=186, ECT-naive [ECT]). The second included a subset of ECT+ participants (n=38) with adequate ECT trials in their current depression episode compared with ECT participants blindly matched on clinical variables associated with TMS outcomes. In the third analysis, the researchers explored TMS outcomes in relation to positive/negative response to prior ECT for a subset of participants with available data.

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Compared with ECT participants, ECT+ participants were more likely to have past psychiatric hospitalizations and more severe depression at baseline (P <.01 and P =.07, respectively).

In 1 analysis, the researchers found that ECT participants had higher rates of response and remission compared with ECT+ participants (P =.07 and P =.02, respectively). However, in an analysis of participants matched on confounding factors, history of ECT was not a significant independent predictor of TMS outcomes.

The researchers did not find that differential responsiveness to ECT and ECT treatment characteristics significantly affected TMS outcomes.

The study had several limitations, including a lack of standardized assessments during ECT courses.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Yuan S, Tirrell E, Gobin AP, Carpenter LL. Effect of previous electroconvulsive therapy on subsequent response to transcranial magnetic stimulation for major depressive disorder [published online October 6, 2019]. Neuromodulation. doi:10.1111/ner.13046