In addition to sham controlled trials, there have also been a series of trials comparing HFL-TMS to ECT [19-22]. Encouragingly, these have reported no differences in responses rates between ECT and HFL-TMS except for one study including psychotic patients (showing greater benefit with ECT in the psychotic group [22]) and a second trial which recently reported better responses with bilateral or unilateral ECT of unlimited treatment duration compared to a fixed course of 3 weeks of unilateral left PFC rTMS [23]. However, some of these studies have not necessarily had sufficient power to detect subtle differences between the groups.