Table 2.
Comparison among rTMS, tDCS, ECT in the treatment of MDD.
| Repetitive transcranial magnetic stimulation (rTMS) | Transcranial direct current stimulation (tDCS) | Modified electroconvulsive therapy (MECT) | |
|---|---|---|---|
| Contraindications | Cochlear implants, brain stimulators or electrodes, aneurysm clips; Implantable electronic devices (such as pacemakers, etc.), implantable defibrillator, a history of epilepsy, or the presence of a brain lesion (vascular, traumatic, neoplastic, infectious, or metabolic) | Implantable electronic devices (such as pacemakers, etc.), serious heart disease, acute large area of cerebral infarction, irritation area with hyperalgesia, increased intracranial pressure, pregnant women, vital signs instability, bleeding tendency patients | Implantable electronic devices (such as pacemakers, etc.), intracranial infections, intracranial tumors, intracranial metal, head trauma, serious heart disease, acute large area of cerebral infarction, irritation area with hyperalgesia, increased intracranial pressure, pregnant women, infants, vital signs instability, bleeding tendency of patients |
| Mechanism of action | The LTP-like and LTD-like effects of rTMS rely on NMDA receptor–mediated glutamatergic function | Modifying synaptic strength NMDA receptor-dependently or altering GABAergic activity (reduced) | Seizure induced changes in neurotransmitters, neuroplasticity and functional connectivity |
| Stimulation site and delivery parameters | High-frequency stimulation (10–20 Hz) over left DLPFC; low-frequency stimulation (≤1 Hz) over right DLPFC | Anodal stimulation over left DLPFC; cathodal stimulation over right DLPFC or right OFC (1–2 mA) | Bilateral treatments (both bitemporal and bifrontal) most often use 1.5–2.0 times seizure threshold (ST) and right unilateral 5–6 or even eight times ST |
| Side effects | Scalp pain during stimulation, transient headache, seizure induction, transient hearing loss | Redden of the skin, itching, burning, heat and tingling sensations at the stimulation site | Headache, muscle soreness, nausea and myalgia, cognitive impairment (such as retrograde amnesia) |
| Advantages | Non-invasive, lower cost | Non-invasive, portable, easy to use, long-acting, lowest cost | Most effective among three therapies |