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Treatment-resistant depression – a form of depression that does not improve with antidepressant medication or psychological counselling – is reasonably common. We estimate that between 100,000 and 200,000 Ontarians suffer from treatment-resistant depression.

The most effective treatment for treatment-resistant depression is electroconvulsive therapy. Electroconvulsive therapy involves doctors using a machine to send a brief electrical signal to a patient’s brain to cause a generalized seizure. The patient does not experience convulsions due to anesthesia.

In spite of the availability of new electroconvulsive therapy techniques that have significantly reduced side effects, some patients do not want to have electroconvulsive therapy because they fear medical complications or side-effects like memory loss. In a small number of cases, patients are ineligible for electroconvulsive therapy because the treatment is unsafe for their health. In other circumstances physicians do not offer electroconvulsive therapy, limiting access to patients who may be candidates for the treatment.

Repetitive transcranial magnetic stimulation is a non-invasive technique that does not require anesthesia and delivers intense magnetic pulses into the brain. It can be used as a possible alternative for patients who cannot have electroconvulsive therapy. The aim is to stimulate the area of the brain associated with mood regulation to help treat symptoms of depression.

Based on the evidence, Ontario Health concluded that electroconvulsive therapy provides better outcomes for patients with treatment-resistant depression, but recommends that repetitive transcranial magnetic stimulation be publicly funded for patients where electroconvulsive therapy is not an option.