For patients with severe, refractory, or rapidly deteriorating depression, device-based treatments can be lifesaving. TMS/ECT for Depression explains how to choose and run protocols that maximize response while minimizing risk. We compare mechanisms and indications: ECT delivers controlled seizures that robustly treat psychotic or catatonic depression and acute suicidality; TMS modulates cortical networks to lift mood and cognitive control without anesthesia. Patient selection is systematic—episode duration, polarity history, medical comorbidity, medication failures, suicide risk, cognitive baseline, and logistical feasibility. We outline ECT workflows (medical clearance, anesthetic choice, unilateral vs bilateral placement, seizure quality indices, continuation/maintenance schedules) and TMS options (targeting, frequency, train parameters, iTBS, session counts). Safety and comfort matter: anticholinergic/antihypertensive use, bite protection, post-ictal monitoring for ECT; scalp discomfort mitigation and hearing protection for TMS. We emphasize communication—set expectations about course length, transient effects (headache, myalgia, memory complaints), and the plan for maintenance or transition back to meds and psychotherapy. Measurement is tight: weekly depression and function scales, suicidality checks, and cognitive spot tests. Equity considerations include transport, caregiver support, and cost; we discuss hub-and-spoke models and day-hospital pathways to widen access. Finally, we integrate care: coordinate with psychotherapy (behavioral activation during energy lift), sleep stabilization, nicotine/alcohol treatment, and relapse-prevention scripts. When teams match indication to modality and manage the details, TMS/ECT for Depression, discoverability via an ECT and TMS conference, and closely allied concepts like electroconvulsive therapy provide a clear route from crisis to recovery.