Lived Experience of People Who Have Received Both Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) for Treating Major Depressive Disorder: a Narrative Inquiry

Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are two evidence-based treatments for major depressive disorder. Both work by stimulating the brain (a process known as neuromodulation), but they differ markedly in invasiveness. ECT requires a general anaesthetic, whereas TMS is delivered while a person is awake and alert and they can go home immediately afterwards. TMS has been proposed as an alternative to ECT for some people. However, TMS is not as effective as ECT in all cases, is generally slower acting, and remains less widely available.

In Nottingham and Liverpool, we have identified a small number of individuals who have experienced both ECT and TMS across different episodes of depression. One such individual is a lived experience co-researcher on our team. Whilst previous studies have explored experiences of ECT and TMS separately, often using relatively superficial methods, none have examined the perspectives of people who have received both treatments. This study addresses that gap through an in-depth exploration of their experiences.

We will use a narrative inquiry approach that encourages participants to tell the story of their experiences of ECT and TMS in their own words. Eligible participants will be adults who have previously received both treatments for depression. Participation involves four sessions: a structured discussion to map the timeline of their depression and treatments, two in-depth open-ended interview sessions (narrative inquiry), and a follow-up discussion about the researchers' reconstruction of their story. Recruitment will take place through services in Nottingham and Liverpool.

This study will help us understand how patients relate to, and make sense of, ECT and TMS, which contextual factors shape their experiences, and how these treatments fit into broader recovery journeys. The findings will inform development of patient-centred services, support shared decision-making, and promote a compassionate understanding of treatment experiences among healthcare professionals.