Our aim was to determine whether rTMS treatments could be substituted for ECT treatments in a course of ECT, 1) without loss of antidepressant effect, and 2) without increase in subjective side-effects. We used a randomized, single-blind, controlled study. Two streams were conducted. Stream 1 received non-dominant unilateral (UL) ECT only, treatments being given 3 times per week for 2 weeks. Stream 2 received a combination of treatments: one UL ECT on Day 1 and rTMS on the following 4 days, all repeated once, after a 2-day respite. Twenty-two patients were recruited and 11 were allocated to each stream. There was no evidence that the antidepressant effect of the ECT only stream was superior to that of the ECT plus rTMS stream. There was no increase in subjective side-effects in the ECT plus rTMS stream. On the contrary, this stream was accompanied by less side effects than the ECT only stream in this study. In conclusion, we have determined that it is possible to substitute rTMS treatments for ECT treatments in a course of ECT without loss of antidepressant effect or an increase in subjective side-effects, using the described parameters. It is possible that the combination of ECT plus rTMS will provide a means of avoiding some of the subjective side-effects encountered with the conventional course of ECT. Further studies are indicated.