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Electroconvulsive therapy (ECT)

Explains what electroconvulsive therapy (ECT) is, when it might be used and what happens during the treatment.

What alternatives are there to ECT?

NICE guidelines say you should only be offered ECT if you have tried other treatments and found them unsuccessful, unhelpful or unacceptable, or you are so unwell that you are unable to benefit from them.

These other treatments might include medication, talking therapies, or arts and creative therapies.

If these treatments haven’t helped, it doesn’t mean you have to try ECT. Our guide to seeking help for a mental health problem has some suggestions for speaking to your doctor about other treatments.

Other physical treatments

Transcranial magnetic stimulation (TMS)

TMS is another physical treatment which can sometimes be used as an alternative to ECT or antidepressants. It stimulates the brain using magnetic fields.

NICE guidance says that there are no major safety concerns with TMS. Research has shown that it can be helpful in treating depression, but the benefits may vary for different people. TMS is now available on the NHS in some hospitals.

The advantages of TMS are that it does not require a general anaesthetic, and does not normally cause a seizure, so is much less likely than ECT to cause memory loss.


If nothing else has helped, including ECT, and you are still severely depressed, you may be offered neurosurgery for mental disorder (NMD), deep brain stimulation (DBS) or vagus nerve stimulation (VNS).

This information was published in July 2019. We will revise it in 2022.

References and bibliography available on request.

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