If you’ve been living with depression and traditional treatments haven’t provided enough relief, you may feel frustrated, discouraged, or unsure about what to try next. The good news is that advances in mental health care have created new treatment options for people who continue to struggle despite medication and therapy.
Two of the most effective treatments available today for treatment-resistant depression are Transcranial Magnetic Stimulation (TMS) therapy and Spravato® (esketamine). Both have helped many people find meaningful relief from depressive symptoms, but they work in very different ways.
Understanding the differences between TMS and Spravato can help you have a more informed conversation with your provider and determine which treatment may be the best fit for your needs.
What Is TMS Therapy?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-cleared treatment that uses gentle magnetic pulses to stimulate areas of the brain involved in mood regulation.
Research has shown that depression can be associated with reduced activity in certain regions of the brain, particularly the left prefrontal cortex. TMS works by activating these underactive neural pathways, helping the brain function more effectively over time.
During treatment, a magnetic coil is placed against the scalp. The device delivers targeted magnetic pulses while you remain awake and comfortable in a treatment chair.
What are the Benefits of TMS Therapy?
- Non-invasive treatment
- No anesthesia or sedation required
- No systemic medication enters the bloodstream
- Patients can drive themselves to and from appointments
- Minimal side effects for most individuals
- Proven effectiveness for treatment-resistant depression
The most common side effects are mild scalp discomfort or headaches, which often improve as treatment progresses.
What Is Spravato?
Spravato (esketamine) is an FDA-approved prescription nasal spray used alongside an oral antidepressant to treat adults with treatment-resistant depression and certain cases of major depressive disorder with suicidal thoughts or actions.
Unlike traditional antidepressants, which can take weeks to become effective, Spravato works on the brain’s glutamate system. This pathway is believed to help create new neural connections and restore communication between brain cells affected by depression.
Spravato is administered in a certified medical office, like our Clearwave clinics, under the supervision of trained healthcare professionals.
What are the Benefits of Spravato?
- May provide relief more quickly than traditional antidepressants
- Offers a different approach for people who have not responded to other treatments
- Can help reduce severe depressive symptoms
- Administered under close medical supervision
Because Spravato can cause temporary side effects such as dizziness, dissociation, sedation, or increased blood pressure, patients must remain in the clinic for monitoring after each treatment and cannot drive themselves home on treatment days.
How Do TMS and Spravato Compare?
While both treatments are designed to help people with treatment-resistant depression, there are several important differences.
Treatment Method
TMS Therapy: Uses magnetic stimulation delivered externally through the scalp.
Spravato: Uses a prescription nasal spray containing esketamine.
Treatment Experience
TMS Therapy: Patients remain fully alert during treatment and can immediately return to normal daily activities.
Spravato: Requires in-office administration and observation for approximately two hours after treatment.
Side Effects
TMS Therapy: Typically limited to mild scalp discomfort or headaches.
Spravato: May cause temporary dissociation, dizziness, nausea, sedation, or elevated blood pressure.
Time Commitment
TMS Therapy: Usually involves multiple sessions per week over several weeks.
Spravato: Begins with a more frequent dosing schedule before transitioning to maintenance treatments based on individual response.
Medication Considerations
TMS Therapy: Does not require introducing another medication into the body.
Spravato: Is used in conjunction with an oral antidepressant and involves a medication-based approach.
Who May Be a Good Candidate for TMS Therapy?
TMS may be a good option for individuals who:
- Have not experienced sufficient improvement with antidepressant medications
- Have difficulty tolerating medication side effects
- Prefer a non-medication treatment approach
- Want to remain fully alert and active throughout treatment
- Are seeking a long-term solution that targets brain activity directly
The great thing that patients find with TMS is that you can generally continue working, caring for your family, and maintaining your usual routines without interruption.
Who May Be a Good Candidate for Spravato?
Spravato may be appropriate for individuals who:
- Have treatment-resistant depression
- Need an alternative approach after multiple medication trials
- May benefit from a treatment that can work more rapidly
- Are comfortable with a medication-based treatment plan
- Can commit to in-office monitoring requirements
Because every person’s experience with depression is unique, eligibility for Spravato should be determined through a thorough psychiatric evaluation.
Is One Treatment Better Than the Other?
The short answer is no. The best treatment depends entirely on you, your symptoms, treatment history, medical profile, lifestyle, and personal preferences.
Some patients prefer TMS because it is non-invasive and does not involve additional medication. Others may find Spravato appealing because of its unique mechanism of action and potential for relatively rapid symptom improvement.
In some cases, a provider may recommend one treatment over the other based on factors such as:
- Previous treatment responses
- Co-occurring mental health conditions
- Medication tolerance
- Scheduling and lifestyle considerations
- Clinical goals and symptom severity
The most important step is receiving a comprehensive evaluation from an experienced mental health professional who can help guide the decision-making process.
TMS Therapy vs Spravato FAQs
What is the difference between TMS therapy and Spravato?
TMS therapy uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation, while Spravato is a prescription nasal spray containing esketamine that works through the brain’s glutamate system. Both treatments are FDA-approved for treatment-resistant depression but use different approaches to help relieve symptoms.
Is TMS therapy more effective than Spravato?
Neither treatment is universally more effective than the other. The best option depends on your symptoms, treatment history, medical needs, and personal preferences. Some patients respond better to TMS, while others achieve better results with Spravato. A mental health professional can help determine which treatment may be most appropriate for you.
How quickly does TMS therapy work?
Many patients begin noticing improvements within several weeks of starting TMS therapy, although response times vary. Some individuals experience gradual symptom relief throughout the treatment course, while others may notice changes sooner.
How quickly does Spravato work?
Spravato may provide symptom improvement faster than traditional antidepressants for some patients. While results vary from person to person, some individuals report feeling relief within days or weeks of beginning treatment.
Can I drive after TMS therapy?
Yes. Most patients can drive themselves to and from TMS appointments and return to work, school, or other daily activities immediately after treatment.
Can I drive after a Spravato treatment?
No. Patients receiving Spravato must arrange transportation home after treatment because the medication can temporarily affect alertness, coordination, and perception.
Is TMS therapy covered by insurance?
Many insurance plans cover TMS therapy for patients who meet specific clinical criteria, particularly those with treatment-resistant depression. Coverage requirements vary by provider and plan.
Is Spravato covered by insurance?
Many insurance providers offer coverage for Spravato treatment when medical necessity requirements are met. Coverage details and authorization requirements differ between plans.
Can TMS therapy and Spravato be used together?
In some cases, mental health providers may recommend combining different treatment approaches as part of a comprehensive care plan. The suitability of combining treatments depends on an individual’s clinical needs and should be discussed with a qualified provider.
Finding the Right Path Forward
Living with depression can be exhausting, especially when previous treatments have not delivered the results you hoped for. However, treatment-resistant depression does not mean treatment-impossible depression.
Both TMS therapy and Spravato represent important advances in mental health care and have helped many individuals regain hope, improve daily functioning, and reconnect with the things that matter most.
At Clearwave Mental Health, we understand that choosing a treatment can feel overwhelming. Our team takes the time to understand your unique experience, answer your questions, and develop a personalized treatment plan that aligns with your needs and goals.
If you’re wondering whether TMS therapy or Spravato may be right for you, we’re here to help you explore your options and take the next step toward feeling better.
Looking for a full service psychiatric practice in your New York State area? We are a New York State mental health facility, specializing in talk therapy, TMS therapy and Spravato, with clinics in Poughkeepsie, Middletown, Valhalla, Nanuet, Garden City, Latham, Hauppauge, and New Rochelle.
