Electroconvulsive therapy (ECT) has a long history in treating depression and its benefits are well known. Repetitive transcranial magnetic stimulation (rTMS) has been introduced more recently to the treatment spectrum.

To test the equivalence of rTMS with ECT, and compare the neurocognitive side effects of both treatment modalities.

This is a randomized comparative study, forty patients with major depressive disorder referred for ECT were randomly assigned to either a 20 session course of r TMS to the left dorsolateral prefrontal cortex or a standard course of ECT. The primary outcome measure was the score on the Hamilton Depression Rating Scale HAM-D. Secondary outcome measures were cognitive battery that assessed different aspects of cognitive functions and a subjective mood visual analogue scale. The cognitive battery comprised the Rey-Osterrieth complex figure test, the Trail making test A and B, the Digit span subtest from the Wechsler Adult Intelligence Scale.

ECT was more effective than rTMS in the short-term treatment of major depressive disorder as evident by HAM-D scores. rTMS was well tolerated with less impact on the cognitive functions compared to ECT. Level of improvement by ECT was correlated with older age, and severe baseline HAM-D symptoms, while the level of improvement by rTMS was correlated with more memory affection at the end of treatment.

ECT was more effective than rTMS in the short-term treatment of major depressive disorder regarding the overall mood symptoms. rTMS was well tolerated with less impact on the cognitive functions.