Module 7: Discussion — Psychotropic Alternatives – Discussion Board Group 4

If your LAST name begins with the letter A through J, please address the following:

  1. Compare and contrast ECT and TMS. For this discussion, at a minimum, include how the therapy works, for which symptoms it is used, and advantages/disadvantages.
  2. Discuss n-acetylcysteine. For this discussion, include the mechanism of action, for what it is used in psychiatry and an example of evidence for or against its use.



*There is no voiceover PowerPoint for this module.

Psychotropic alternatives

Many times, individuals think “therapy and meds” are the only treatments in psychiatry. There are many other treatments that can augment or be used as an alternative. In this brief lecture, we will discuss electroconvulsive therapy and repetitive transcranial magnetic stimulation. However, these are just two—others include ketamine, herbs and supplements, medical food, deep brain stimulation and vagus nerve stimulation. (Note: some of these treatments are more common than others). Please see the PowerPoints for more information on other topics.

Electroconvulsive Therapy

ECT is the induction of a grand mal (generalized) seizure through the careful application of electrical current through the brain. The electricity is passed between two electrodes placed bilaterally in the frontotemporal region or unilaterally on the same side as the dominant hand. The dose of stimulation is based on the client’s seizure threshold, which is highly variable among individuals. The duration of the seizure usually lasts between 30 and 60 seconds. ECT is usually administered every other day, for three times per week, with most clients need 6 to 12 treatments. The most common side effects are  temporary memory loss and confusion.


ECT has been shown to be effective in the treatment of severe depression. It is usually considered in cases of severe depression resistant to medication or accompanied with psychosis or suicidal intent. ECT is also indicated in the treatment of acute manic episodes that are unresponsive to antimanic drug therapy. Additionally, ECT is used in schizophrenia when symptoms are severe or medications are only partially effective.


The only absolute contraindication for ECT is increased intracranial pressure. Individuals considered to be at risk are those with myocardial infarction or CVA within the preceding 3 months, aortic or cerebral aneurysm, severe underlying hypertension, or CHF.

Repetitive Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation is a non-invasive therapy involving the electrical stimulation of neural tissue for treatment resistant Major Depressive Disorder. It has had FDA approval since 2008.

TMS uses a small electromagnetic coil to deliver short bursts of magnetic energy, focused on the left side of the brain’s frontal cortex. The TMS magnetic fields are similar in type and strength to those produced by a MRI machines. A coil is placed on the head above the targeted area of the brain. The TMS magnetic fields only reach between 2-3 centimeters into the brain, directly below the coil; as they move into the brain they produce small electrical currents. Unlike ECT, the current does not reach deep structures, anesthesia is not required and no seizure is induced

Advantages & Disadvantages

Advantages of TMS include: it is done on an outpatient basis and patient can drive themselves to and from appointment (due to no anesthesia), low side effect profile, generally well tolerated. However, it takes a high level of commitment; the patient must come daily for 4-6 weeks with each session lasting around 35 minutes. Potentially side effects include headache, discomfort at stimulation site, temporary increase in auditory threshold, rarely it may induce mania or seizures. Contraindications include metal plate in head, pacemaker, cochlear implant; things that place patient at an increased risk for seizure are infection, seizure disorders, head trauma and lack of sleep


Additional Lecture Materials

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