If you’ve tried medication after medication and still don’t feel like yourself, I want you to know: you haven’t run out of options. TMS and Spravato are two of the most significant advances in psychiatric care in the last decade, offering real relief for depression that hasn’t responded to traditional treatment alone.
When Traditional Treatment Isn’t Enough
Antidepressants work well for many people, but not everyone. If you’ve tried two or more medications without lasting relief, you may be dealing with treatment resistant depression, and that’s exactly where TMS and Spravato can make the biggest difference. Both are FDA approved options designed for people in exactly this situation, and both work in ways that are fundamentally different from a daily pill.
What Is TMS (Transcranial Magnetic Stimulation)?
TMS uses gentle, targeted magnetic pulses to stimulate the areas of the brain involved in mood regulation, the same technology used in MRI machines, applied in a focused, noninvasive way.
- No anesthesia, sedation, or systemic side effects like weight gain or sexual dysfunction
- You stay fully alert and can drive yourself home after each session
- FDA cleared for treatment resistant major depressive disorder, and for OCD in appropriate candidates
Time commitment: This is one of the biggest practical considerations with TMS, so it’s worth planning for honestly. A typical course involves sessions five days a week for about four to six weeks, with each visit lasting roughly twenty to thirty minutes (the very first session runs a bit longer, since it includes mapping to find your personal treatment settings). Many patients build this into their routine the way they would a lunch break or a gym visit, and some tapering sessions may follow the main course. It’s a real commitment, but one that’s confined mostly to short, predictable blocks of time rather than long appointments.
Many patients describe TMS as reawakening parts of their mood and motivation that felt shut off for years.
What Is Spravato (Esketamine) Treatment?
Spravato is an FDA approved nasal spray, derived from ketamine, for treatment resistant depression and for depression with suicidal thoughts. Unlike traditional antidepressants that can take weeks to build up in your system, Spravato works on a different brain pathway, and many patients notice a shift in their outlook within days of starting treatment.
- Administered in the medical office under direct medical supervision, as required by the FDA’s REMS safety program
- Used alongside an oral antidepressant, not as a standalone medication
- Often considered when someone needs a faster acting option, including in more urgent situations
Time commitment: Spravato asks for more time per visit than TMS, and it helps to know this upfront. Each appointment includes the medication itself plus a required observation period afterward, so plan for roughly two hours in the office per visit. You’ll also need someone to drive you home, since you should not drive the same day. The typical schedule starts with two visits a week for the first month, then tapers to weekly visits, and eventually to a maintenance visit every one to two weeks. It’s a bigger time investment early on, but it tends to ease as your treatment progresses.
Is TMS or Spravato Right for You?
You may be a good candidate if:
- You’ve tried two or more antidepressant medications without meaningful improvement
- Side effects from previous medications have been difficult to tolerate
- Your depression or anxiety is affecting your ability to work, connect with loved ones, or feel like yourself
- You’re looking for a treatment path that doesn’t rely on adding another daily pill
Time and scheduling are often the deciding factor between the two, and that’s a completely valid part of this decision. Someone with a flexible daily schedule may find TMS’s shorter, more frequent visits manageable, while someone who can carve out longer blocks a few times a week, and has a reliable ride home, may find Spravato’s schedule fits better. Everyone’s path to treatment resistant depression looks different, which is why a personal evaluation, not a checklist, is the best way to determine which option fits your biology, your history, and your goals.
What to Expect: Getting Started
Your first step is a comprehensive evaluation where I review your treatment history, current symptoms, and overall health picture. From there, we talk through whether TMS, Spravato, or a combination with medication management and integrative support is the right fit, and what the treatment schedule would realistically look like for your life, including how it fits around work, family, and transportation.
You are never just handed a protocol. Every plan is built around your goals, your history, and what “better” looks like for you.
Take the Next Step
You don’t have to keep cycling through medications that aren’t working. Contact me to schedule a consultation to find out whether TMS or Spravato could be the turning point in your mental health journey.
