More than 21 million adults in the United States experienced a major depressive episode in 2021, and over 30% of those people didn’t respond well to traditional antidepressant medications.1 That’s where specialized interventional services like TMS and Spravato® come in. Both have been cleared by the FDA for treating difficult-to-treat depression.
Both are evidence-based and approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression. However, they differ significantly in how they work, how they are administered, and what to expect during the process.
What Is TMS?
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate nerve cells in the brain. The goal of TMS is to help improve communication in the parts of the brain that affect mood, which may have become underactive due to depression. It’s an excellent option for people who want to avoid medications or have trouble tolerating them since it doesn’t involve medication, anesthesia, or downtime for recovery.
At Northeast Health Services, we use NeuroStar® TMS, an FDA-approved treatment designed to be effective while minimizing side effects. Sessions typically occur five days a week over several weeks, and clients can return to normal activities immediately after each visit.
What Is Spravato?
Spravato® is a nasal spray form of esketamine, a medication derived from ketamine. It works to boost glutamate production in the brain, helping different parts of the brain better communicate with each other and overall boosting mood. Spravato® must be administered under medical supervision in a clinical setting due to its fast-acting nature and potential side effects like dissociation and increased blood pressure.
Doctors typically recommend Spravato® for adults with difficult-to-treat depression, or those experiencing depressive symptoms accompanied by suicidal thoughts. Usually paired with an oral antidepressant for best results, people often feel the effects of Spravato® quite quickly, even within hours of the first dose.
Northeast Health Services is dedicated to supporting your mental health. If you’re experiencing suicidal thoughts, we encourage you to reach out for immediate support through your local crisis services by dialing 988, contacting your local emergency services, or visiting your local emergency room.
Key Differences Between TMS & Esketamine (Spravato®)
Both options can help people struggling with severe depression, but they are different in many ways. For one thing, the administration is very different: Spravato® is a nasal spray, while TMS sessions involve placing electrodes on the head.
TMS sessions typically last between 20 and 50 minutes, while Spravato® treatment is almost instant, but patients must be monitored for two hours afterward and cannot drive themselves home. After a TMS session, a client can go about their day, including driving. TMS typically takes a few weeks of regular sessions to see the full effects, while Spravato® can start working within hours.
Thankfully, both have been approved by many insurance plans for treating hard-to-treat depression, though eligibility requirements may vary based on your specific plan.
Which Is More Effective for Treating Depression Symptoms?
Studies show that both TMS and Spravato® can be really effective at treating difficult-to-treat depression, especially when compared to simply trying another antidepressant medication. There are very few head-to-head comparisons of the two treatment options, but initial data shows that TMS may have slightly lower risks of medical complications, though esketamine (Spravato®) was slightly more impactful at mitigating suicidality, especially during the first 30–90 days.2,3
Potential Side Effects of TMS vs Spravato®
TMS is generally well-tolerated, with possible mild discomfort at the treatment site. A few clients report having headaches, mild dizziness, or sound sensitivity right after administration.
Spravato® may cause side effects like dizziness, nausea, or dissociation during or after treatment. There is a higher risk of increased blood pressure right after administration, which is why staying for a two-hour observation after your dosage is a mandatory part of treatment.
TMS vs Spravato®: Which Is Right for You?
Everyone responds somewhat different to depression treatments, but there are some clear cases where one option could be more beneficial. As with all mental health treatment, it’s important to discuss your options with a licensed mental health professional who can talk you through what would be best for your needs.
TMS could be a good fit if:
- You prefer a non-medication approach with few side effects
- You’re able to attend daily or almost-daily sessions
- You want to be able to drive home same-day
Spravato® could be a good fit if:
- You’re looking for fast-acting relief from severe symptoms
- You don’t want to go into a clinic more than twice a week
- You have someone who can drive you home from appointments
TMS & Spravato® as Part of a Well-Rounded Treatment Plan
Modern interventional treatments like transcranial magnetic stimulation and Spravato® can be life-changing, but experts find they work best alongside a comprehensive care plan. Treatment for depression should also include ongoing talk therapy to help you process your emotions and learn new coping skills.
Spravato® treatments also commonly include the use of another oral antidepressant medication for maximum effectiveness, so a psychiatric provider may prescribe that and track symptoms as part of your treatment.
Connect with Northeast Health Services for Comprehensive Depression Treatment
Navigating difficult depression can be overwhelming, but you don’t have to go it alone. If you’re considering transcranial magnetic stimulation therapy or Spravato® for depression treatment, we’re here to discuss your options and find a plan that works for you.
At NEHS, our priority is helping you take care of your mental health in a way that fits your life. Call today at 508.794.8711 to learn more or schedule an appointment. For existing clients, please find your office location to contact your office directly.
Footnotes:
- Major Depression. (2023). National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
- Jen-Ping Chen, Chih-Wei Hsu, Yi-Ting Chen, Yi-Ya Fang, Ping-Tao Tseng, Mu-Hong Chen, Yu-Chen Kao, Tien-Wei Hsu, Chih-Sung Liang. (2026). Comparison of rTMS and esketamine for treatment-resistant depression: A target trial emulation. Journal of Affective Disorders, 399. https://doi.org/10.1016/j.jad.2025.121132
- Kaster, T. S., Dai, Y., Vila-Rodriguez, F., Downar, J., Daskalakis, Z. J., Blumberger, D. M., & Rhee, T. G. (2025). Efficacy of intranasal esketamine versus rTMS for treatment-resistant depression: analysis of individual participant data from two clinical trials. EClinicalMedicine, 90, 103609. https://doi.org/10.1016/j.eclinm.2025.103609