Objective To compare the antidepressive effect and cognitive imfluence of modified electroconvulsive therapy （MECT）and repetitive transcranial magnetic stimulation （rTMS）on medica-tion-resistant depression patients. Methods Totals of 40 patients with treatment-refractory and non-psy-chotic major depression were randomly divided into MECT group and rTMS group. They received two weeks oftreatments with either MECT or rTMS and were assessed for efficacy and cognitive impairments before and after 1 and 2 weeks treatment by Hamilton Rating Scale for Depression （HAMD）and Clinical Memory Scale. Treat-ment Emergent Symptom Scale （TESS）was used to evaluate the side-effects. Moreover，medical examination， electrocardiogram and electroencephalogram examination were performed before and after treatment for safety.Results There was no difference between two groups before and at the end of week 1 and 2 on the total HAMD score （P=0.610，P=0.235）and cognitive impairment factors （P=0.639，P=0.793）. However，Clinical Memo-ry Scale score and all factors of rTMS group was improved markedly at the end of week 2（P＜ 0.05）. Directed memory score，free recall deficit of picture score，image free recall score and portrait character recall score of MECT group was declined at the end of week 2（P＜0.05）. And the total score，directed memory score and por-trait character recall score of MECT group was lower than that of rTMS group（P＜ 0.05）. There was no significant difference between the two groups on the incidence of nausea，vomiting，headache（P＞ 0.05），and more patientscomplained of memory decline in the MECT group （P＜ 0.05）.Conclusions rTMS and MECT have similar effi-cacy in treating treatment-refractory non-psychotic major depression. But rTMS is benefit to the improvement of cognitive performance with more safety than MECT.