What Is TMS?
Transcranial magnetic stimulation (TMS) is a noninvasive depression treatment that uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation. Treatment typically targets the region of the brain associated with mood and emotions.
During a session, a magnetic coil is positioned against your head to deliver brief pulses that stimulate the targeted area. Unlike an antidepressant medication, TMS does not circulate through your bloodstream, and it does not require sedation. You’ll remain awake and alert throughout the entire treatment process.
When to Consider TMS
TMS is generally considered when antidepressants, psychotherapy, or other approaches have not provided enough relief. If you’ve tried a few treatments and still don’t feel like yourself, TMS is an option that you may want to discuss with a provider. It may also appeal to anyone who would rather try a treatment option that doesn’t involve any medication.
TMS is a device-based treatment and has been FDA-cleared for major depressive disorder since 2008, and it is also cleared as an add-on treatment for OCD.
Before you begin treatment, your provider will review your medical history to make sure TMS is appropriate for you. That includes asking about certain implanted devices or metal near the head, and any history of seizures.
Learn more about TMS treatment at APH.
If depression hasn’t improved with medication and you’re considering Spravato® or TMS, our team is happy to talk through both with you. Most new patients are seen within 1-3 days.
What Is Spravato®?
Spravato® is an FDA-approved prescription nasal spray derived from ketamine. It is used to treat adults with treatment-resistant depression, meaning their depression has not improved adequately with standard antidepressants.
Spravato® works differently from many traditional antidepressants, which primarily affect serotonin. Instead, esketamine acts on a different system in the brain involving glutamate and NMDA receptors. Researchers are still learning exactly how these effects lead to improvements in depression, but Spravato® offers another treatment approach when traditional medications have not provided enough relief.
When to Consider Spravato®?
Spravato® may be worth considering for people who have not responded to medication. If you’ve been through multiple medications without the results you hoped for, it’s one of the next options a provider may want to talk through with you.
Since January 2025, Spravato® has been FDA-approved as a monotherapy treatment for adults with treatment-resistant depression. This means it can be taken on its own without an oral antidepressant or alongside one, depending on what your provider recommends. Spravato® is also approved, in combination with an oral antidepressant, for adults with major depressive disorder experiencing acute suicidal thoughts or behavior.
Spravato® is administered in a certified healthcare setting under a required safety program called the Risk Evaluation and Mitigation Strategy (REMS). Patients self-administer the nasal spray under supervision and remain at the treatment site for monitoring because temporary changes in perception, alertness, and blood pressure may occur.
Learn more about the Spravato® treatment at APH.
How the Two Treatments Compare
The most meaningful differences between TMS and Spravato® involve how each treatment works, what a session feels like, how often you attend appointments, and what you need to plan around treatment.
| Consideration | TMS | Spravato® |
|---|---|---|
| Treatment type | Noninvasive, magnetic stimulation | Prescription esketamine nasal spray |
| Typical session time | About 20 to 40 minutes | At least 2 hours of monitoring after administration, plus check-in and preparation |
| Medication involved | No | Yes |
| Alertness during treatment | Awake and alert, without sedation | Temporary dissociation, dizziness, or sleepiness may occur |
| Driving afterward | Usually possible if you feel well and your provider has no concerns | No driving until the next day after a restful sleep |
| Typical initial schedule | Five days per week for about 4 to 6 weeks | Twice weekly for 4 weeks, then weekly for weeks 5-8 |
| Treatment setting | Outpatient clinic | Certified outpatient healthcare setting with monitoring |
Every patient is different, so expectations and outcomes will vary depending on the schedule and protocol that works best for you. Your provider will walk you through what to expect at each appointment so you can feel prepared and supported throughout the process.
What Each Treatment Feels Like
TMS: You remain conscious throughout the session. You will hear clicking sounds and feel tapping or pulsing against your scalp as the device delivers magnetic stimulation. Some people experience scalp discomfort or headaches, particularly early in treatment. On the other hand, some patients have expressed they feel extremely calm during treatments because of the relaxing setting where the treatment happens. Your care team will work with you to address any unease or discomfort before and during treatment.
Spravato®: The experience can be more noticeable throughout the body and many people experience a notable amount of dissociation, a temporary feeling of detachment from themselves or their environment. Dizziness, nausea, sleepiness, and temporary changes in blood pressure may also occur. These effects are temporary, and a clinician will monitor you the entire time to help you through the process.
Both treatments vary from patient to patient, and it’s impossible to know exactly how you will respond. That’s why it’s best to be open and honest with your provider about your medical history when you’re deciding which treatment will work best for you.
How Quickly Might You Notice Relief?
TMS generally involves a gradual course of treatment. Some people begin noticing changes after two to four weeks of consistent sessions, although improvement may take longer and varies from person to person.
Some people report improvement within hours or days of starting Spravato®, but this timeline isn’t guaranteed. Others need more time and repeated sessions before their provider can assess the treatment’s effect.
A faster initial change does not automatically make one option better for a particular person. The important questions are whether symptoms improve meaningfully, whether those changes are sustained, and whether the treatment remains appropriate as care progresses.
Effectiveness and Long-Term Treatment
Both TMS and Spravato® have clinical research supporting their use for depression in appropriate patients. However, study results depend on the treatment protocol, the people included in the research, and how researchers define response or remission. No single percentage can reliably predict an individual’s response to treatment.
Neither treatment works for everyone. Not responding to TMS does not necessarily mean Spravato® will be ineffective, and the reverse is also true. Your history and response to previous treatments can help guide the next decision, but they cannot guarantee a particular result.
Ongoing care may also be necessary. Some people who respond to TMS receive maintenance or booster sessions if symptoms return. Spravato® treatment commonly continues on a maintenance schedule determined by the prescribing provider. Neither should be viewed as a guaranteed one-time cure.
Side Effects at a Glance
Any depression treatment is going to have associated side effects. The best plan of action is to work with your clinician to decide which pros and cons alleviate your specific concerns.
TMS side effects are generally concentrated around the treatment area. Scalp discomfort and headache are among the more commonly reported effects. Seizures are a rare but notable risk, which is why providers screen patients carefully and follow device-specific safety protocols.
Spravato® may cause temporary dissociation, dizziness, nausea, sedation, and increases in blood pressure. These effects generally occur around the treatment session, but their intensity and duration vary. Because of effects like sedation and dissociation, Spravato® is only available through a required FDA safety program called REMS. Each dose is taken under supervision, so your care team can monitor you during and after treatment.
Treatment Schedule for Each
The time commitment can be a deciding factor, especially when symptoms already make everyday responsibilities difficult.
TMS typically involves frequent, shorter visits. A common treatment course involves 20-40 minute sessions five days a week for approximately four to six weeks. Some accelerated TMS protocols are available in the broader field, but availability and suitability depend on the specific clinic and treatment plan.
Spravato® begins with more frequent sessions and then moves to a maintenance schedule. The usual schedule is 2 hours twice per week for the first four weeks and then moves to a weekly cadence during weeks five through eight, and then weekly or every other week depending on response and the prescribing provider’s recommendation.
Spravato® appointments also require planning around transportation and recovery time. Patients must remain under observation for at least two hours after administration and cannot drive until the following day after a restful sleep.
When comparing schedules, it’s important to consider more than the number of appointments. You should also think about travel, work, caregiving, and transportation, in addition to how easily you can make regular visits. At the end of the day, even the most effective treatment plan won’t be able to help you if it doesn’t fit comfortably into your everyday life.
Who May Be a Good Fit for Each Treatment?
There is no checklist that can determine whether Spravato® vs. TMS for depression will be right for you. Regardless, considering your preferences and practical circumstances can help you prepare for a useful conversation with your provider.
TMS may be worth exploring if you:
- Prefer a non-medication approach to depression treatment.
- Want to remain alert during treatment and generally return to your routine afterward.
- Can attend frequent appointments over several weeks.
- Have discussed relevant medical considerations, including any metal implants near your head or history of seizures, with a qualified provider.
TMS may appeal to people who would rather avoid medication-related effects such as sedation or dissociation. However, it is not suitable for everyone, and your provider will need to review your health history and individual risk factors.
Spravato® may be worth exploring if you:
- Have treatment-resistant depression and want to discuss another medication-based option.
- Have tried other treatments, including TMS, without sufficient relief, or prefer to explore a different treatment approach.
- Can arrange transportation home and allow time to rest after each session.
- Can commit to the more frequent initial appointment schedule.
- Are medically eligible after screening for conditions such as uncontrolled high blood pressure and certain cardiovascular or cerebrovascular conditions.
Spravato’s effects and monitoring requirements make it important to plan ahead. Your provider will review your medical history, medications, and other factors before deciding whether treatment is appropriate.
These considerations are a starting point, not a way to diagnose yourself or rule out an option. A full psychiatric evaluation is the most useful way to assess your history, current symptoms, treatment goals, and the potential benefits and risks of each approach.
Can TMS and Spravato® Be Used Together?
In some cases, a provider may consider using TMS and Spravato® together as part of the same treatment plan. They work through different mechanisms, so clinicians may consider combining them when they believe both approaches play a role in an individual’s care.
However, using both treatments is not the default recommendation, and you should not assume combining them produces better results. The decision depends on your treatment history, current symptoms, medical considerations, and response to care.
Cost and Insurance
The cost of Spravato® vs. TMS depends on your insurance plan, eligibility, treatment protocol, and the authorization requirements involved. Both may be covered by insurance when the plan’s clinical criteria are met, including documentation of inadequate response to previous antidepressant treatment. Prior authorization is commonly required, and coverage is not guaranteed.
For Spravato®, coverage may also depend on how the treatment is administered and billed. TMS coverage can vary by insurer and device-based treatment criteria. Before starting either option, ask about your benefits, out-of-pocket expenses, and any documentation needed for approval.
Advanced Psychiatric Health offers insurance verification to help you understand your coverage and plan your next steps. It’s important to check your coverage before treatment begins so you can make a more informed decision without relying on cost estimates that may not apply to your plan.
How to Decide Between Spravato® and TMS
There is no universally better choice between TMS and Spravato®. The right option depends on various factors: your medical history, the treatments you’ve already tried, your response to previous care, the side effects you’re comfortable managing, and the schedule you can realistically maintain.
At Advanced Psychiatric Health, patients can explore both treatments with a provider who can help weigh these considerations without assuming one approach is right for everyone. A full psychiatric evaluation is the only way to determine which treatment may fit your history and goals. Both treatments are offered at several of our mental health clinics across Florida, and our team can help you find the closest office that offers the one you need.
Most patients can see an Advanced Psychiatric Health provider within 72 hours. Request an appointment to get started.
Research doesn’t show that one is more effective for everyone. Both have clinical research supporting their use for depression, and the better fit depends on your medical history and what you can realistically manage day to day. Your provider can help you weigh both.
Possibly. Not responding to one treatment doesn’t mean the other won’t help, and the same is true in reverse. Your provider will look at your history and how you responded to past treatment to guide the next step.
Don’t stop or change any medication without talking to your provider first. Spravato® can be used on its own or alongside an oral antidepressant, and your provider will tell you what makes sense for you.
Typically, yes. Both may be covered by your insurer, but your plan’s criteria can affect coverage, and prior authorization is often required. We recommend verifying your insurance with our team so we can go over your benefits with you before you begin.
Spravato® may bring relief sooner for some people, but timing varies. Some people notice a change within hours or days, while many people begin noticing changes from TMS after about two to four weeks of consistent sessions. A faster start doesn’t make one treatment the better fit for you.
In some cases, yes. A provider may recommend combining them as part of one treatment plan, since they work in different ways. It isn’t the default approach, though, and the decision is made case by case based on your history and how you respond to care.
It depends on the treatment.
After TMS, you can usually drive yourself home the same day if you feel well.
After Spravato®, you’ll need a ride, and you shouldn’t drive until the next day after a restful sleep.