You’ve already done the hard part. You’ve tried the medications, sat through the appointments, and admitted that something needs to change. Now you’re staring at two unfamiliar names, and wondering which one is actually meant for you. TMS vs Spravato.
TMS uses magnetic pulses to stimulate the parts of your brain tied to mood. Spravato is a nasal spray that works through a different chemical pathway entirely. Both are FDA-approved for treatment-resistant depression. Neither one is universally “better.” The right choice depends on your symptoms, your schedule, and what your body has already been through.
Let’s break down what separates them so you can walk into your consultation with real questions instead of guesses.
What Is TMS?
Transcranial Magnetic Stimulation (TMS) delivers focused magnetic pulses to the region of your brain that regulates mood. It’s noninvasive and drug-free. You sit in a chair, fully awake, while a device rests near your scalp for about 20 to 40 minutes.
Most people complete a full course over 4 to 6 weeks, with sessions happening 5 days a week. There’s no sedation involved. You can drive yourself home and return to work the same day.
What Is Spravato?
Spravato (esketamine) is a nasal spray derived from ketamine. Unlike traditional antidepressants, which can take 4 to 8 weeks to show any effect, Spravato often creates noticeable shifts in mood within hours to days.
Treatment happens in a monitored clinical setting. You’ll self-administer the spray under supervision, then stay for about 2 hours while your care team watches for side effects. You cannot drive yourself home afterward, so plan for a ride.
The Real Differences That Matter
How fast do you need relief
If you’re in crisis or dealing with suicidal thoughts alongside depression, Spravato’s faster onset often makes it the first option your provider considers. TMS builds results gradually over weeks, which works well if your situation is serious but not urgent.
How the sessions fit your life
TMS asks for near-daily visits over several weeks, but each one ends with you walking out the door on your own. Spravato sessions happen less frequently, often twice a week during the early phase, but each one requires a ride home and a 2-hour window at the clinic.
What your body needs to tolerate
TMS carries a low side-effect profile. Most people report mild scalp discomfort or a brief headache after early sessions. Spravato can cause temporary dissociation, dizziness, or nausea during the monitoring window, which is exactly why that supervision period exists.
Your treatment history
Providers often look at what you’ve already tried. If standard antidepressants failed and your history includes anxiety alongside depression, TMS sometimes fits better. If you’ve cycled through multiple medication classes without success and need faster stabilization, Spravato may be the stronger fit.
Can You Try Both?
Some patients do. It’s not unusual to start with one treatment, see partial improvement, and add the other for a more complete response. Depression rarely responds to a single lever, and your provider can walk you through what combining treatments might look like for your specific case.
According to the National Institute of Mental Health, brain stimulation therapies like TMS are typically considered after standard depression treatments haven’t produced enough improvement, which lines up with how both TMS and Spravato get used in practice.
How to Start Figuring This Out
Neither treatment works the same for everyone, and that’s exactly why this isn’t a decision to make alone. A real evaluation looks at your diagnosis, your treatment history, and your day-to-day life, not just which option sounds more appealing on paper.
Our team walks you through both options during your first visit. We’ll ask about what you’ve tried, what’s worked, and what hasn’t, and we’ll help you land on a plan that actually fits your life.
Frequently Asked Questions About TMS vs. Spravato,
Does insurance cover TMS or Spravato?
Many insurance plans, including Tricare and Select Health, now cover both treatments for qualifying patients with treatment-resistant depression. Coverage details vary by plan, so we verify your specific benefits before you start.
How do I know if I have treatment-resistant depression?
Providers generally consider depression treatment-resistant after 2 or more antidepressant trials at adequate doses and duration haven’t produced meaningful improvement. If that sounds familiar, it’s worth bringing up at your next appointment.
Is one treatment more permanent than the other?
Neither treatment offers a guaranteed permanent result, and both usually require some form of maintenance. TMS patients sometimes return for booster sessions months later, and Spravato transitions into a less frequent maintenance schedule after the initial induction phase.
Ready to Find Your Fit?
You don’t have to figure this out by guessing. Reach out to our team to schedule a consultation, or visit our homepage to learn more about how we approach treatment-resistant depression at Autumn Leaves Psychiatry. Relief is closer than it feels right now.