{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T05:15:46Z","timestamp":1783142146570,"version":"3.54.6"},"reference-count":185,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad de las Am\u00e9ricas","award":["592.A.XVII.25"],"award-info":[{"award-number":["592.A.XVII.25"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Major depressive disorder, particularly in its treatment-resistant form, remains a leading cause of global disability. When pharmacotherapy and psychotherapy fail, neuromodulation techniques such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are increasingly utilized. However, variability in protocols and outcome reporting continues to generate uncertainty regarding their comparative benefits and safety profiles. Objective: To comprehensively map and synthesize the available evidence on the clinical benefits and adverse effects of ECT and rTMS in adults with major depressive disorder and treatment-resistant depression. Methods: A scoping review was conducted following PRISMA-Sc guidelines and registered in PROSPERO; PubMed\u2013MEDLINE, Scopus, and the Virtual Health Library were searched from inception to October 2022. Observational and experimental studies evaluating ECT and or rTMS in adults with depressive disorders were included. Data were extracted on study design, population characteristics, stimulation parameters, clinical outcomes, and adverse effects. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. Results: A total of 165 studies comprising 10,701 participants were included. ECT and rTMS were consistently associated with clinically meaningful reductions in depressive symptom severity across heterogeneous protocols. ECT demonstrated the most robust response rates, particularly in treatment-resistant and severe depression, while rTMS showed substantial efficacy with a more favorable safety profile. Adverse effects were more frequent and severe with ECT, including transient cognitive disturbances and cardiovascular complications, whereas rTMS was predominantly associated with mild, self-limited side effects such as headache and scalp discomfort. Considerable heterogeneity in stimulation parameters and diagnostic subgroups was observed across studies. Conclusions: Both ECT and rTMS represent effective neuromodulation strategies for major depressive disorder and treatment-resistant depression. ECT remains the most potent intervention in highly refractory cases, whereas rTMS offers a less invasive alternative with strong tolerability. Standardization of stimulation protocols, biomarker-informed stratification, coadjuvancy analysis, and long-term controlled studies are necessary to refine clinical positioning and advance precision neuromodulation in depression care.<\/jats:p>","DOI":"10.3390\/jcm15135194","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:51:25Z","timestamp":1783003885000},"page":"5194","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS), Benefits and Adverse Effects in Patients with Depression: A Scoping Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3284-5311","authenticated-orcid":false,"given":"Miguel Esteban","family":"Carrera-Aguilar","sequence":"first","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Escuela de Medicina, Universidad Internacional del Ecuador, Jorge Fern\u00e1ndez, Quito 170411, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Castro","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Instituto de Neurobiolog\u00eda, Universidad Aut\u00f3noma de M\u00e9xico, Campus UNAM 3001, Juriquilla, Quer\u00e9taro 76230, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"\u00c1lvarez-Mej\u00eda","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Facultad de Psicolog\u00eda, Universidad de Salamanca, Patio de Escuelas, 1, 37008 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Mart\u00edn","family":"Vargas-Villac\u00eds","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Escuela de Medicina, Universidad Internacional del Ecuador, Jorge Fern\u00e1ndez, Quito 170411, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7917-4980","authenticated-orcid":false,"given":"Martina","family":"Coronel","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Escuela de Medicina, Universidad San Francisco de Quito, Campus Cumbay\u00e1, Diego de Robles, Quito 170901, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Pinto-Proa\u00f1o","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Arcentales","sequence":"additional","affiliation":[{"name":"NeurALL-Research Group, Quito 170157, Ecuador"},{"name":"Escuela de Medicina, Universidad Internacional del Ecuador, Jorge Fern\u00e1ndez, Quito 170411, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8130-6460","authenticated-orcid":false,"given":"Jose E.","family":"Leon-Rojas","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n Bienestar, Salud y Sociedad, Escuela de Psicolog\u00eda y Educaci\u00f3n, Universidad de las Am\u00e9ricas, Quito 170124, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). 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