When depression does not improve with standard treatments, it can feel frustrating and discouraging. For some patients, options such as transcranial magnetic stimulation, or TMS, and Spravato may be worth discussing with a psychiatric provider.
Both treatments are used for difficult-to-treat depression, but they work differently and may be appropriate for different patients. The goal of this comparison is not to determine which treatment is “better,” but to help you understand the basic differences before speaking with a professional.
What Is TMS?
TMS is a noninvasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation.
Patients remain awake during treatment, and no medication or anesthesia is required. TMS is generally given through a series of appointments over several weeks.
TMS may be considered for patients who:
- Have not experienced enough improvement from antidepressants
- Have had difficulty tolerating medication side effects
- Prefer a non-medication treatment option
- Can attend regular treatment sessions
Potential Benefits of TMS
- Noninvasive and medication-free
- Usually does not interfere with alertness
- Patients can typically return to normal activities after treatment
- Does not commonly cause systemic side effects such as weight gain or sexual dysfunction
Potential Downsides of TMS
- Requires frequent appointments
- Improvement may develop gradually
- Temporary headaches or scalp discomfort can occur
- Results vary from person to person
TMS directly addresses brain activity and networks associated with depressive symptoms. It does not replace therapy or address every emotional, social, or situational factor that may contribute to depression. You can learn more about the benefits of TMS treatment here.
What Is Spravato?
Spravato is the brand name for esketamine, a prescription nasal spray used for certain adults with treatment-resistant depression.
It works through a different brain pathway than traditional antidepressants. Spravato must be administered in a certified treatment setting, where patients are monitored after each dose.
Spravato may be considered for patients who:
- Have not improved enough after previous antidepressant treatment
- May benefit from a medication with a different mechanism
- Can arrange transportation after appointments
- Are able to remain at the clinic for monitoring
Potential Benefits of Spravato
- Works differently from traditional antidepressants
- Some patients may notice improvement relatively quickly
- Specifically used for treatment-resistant depression
- Treatment frequency may decrease after the initial phase
Potential Downsides of Spravato
- Requires in-office monitoring after each treatment
- Patients cannot drive themselves home
- Temporary dizziness, sedation, nausea, or dissociation may occur
- Ongoing maintenance treatment may be needed
- It is not appropriate for every medical history
Spravato directly addresses depressive symptoms through its effects on brain signaling. Like TMS, it may be one part of a broader treatment plan rather than a complete solution on its own.
TMS vs. Spravato: Key Differences
| Consideration | TMS | Spravato |
| Treatment type | Noninvasive brain stimulation | Prescription nasal medication |
| Main target | Brain networks involved in mood regulation | Glutamate-related brain signaling |
| Medication involved | No | Yes |
| Alertness during treatment | Patients remain awake and alert | Temporary sedation or dissociation may occur |
| Transportation afterward | Patients can usually drive | A ride home is required |
| Appointment schedule | Frequent sessions over several weeks | More frequent at first, then often reduced |
| Common side effects | Headache or scalp discomfort | Dizziness, nausea, sedation, or dissociation |
| Speed of improvement | Often gradual | May occur more quickly for some patients |
Which Treatment May Be Right for You?
The right choice depends on more than a list of benefits and side effects.
A psychiatric provider may consider:
- Your diagnosis and symptom severity
- Previous medications and treatments
- Medical and neurological history
- Current medications
- Scheduling and transportation needs
- Your treatment preferences
- Insurance coverage and cost
Some patients may be better suited for TMS, while others may be more appropriate candidates for Spravato. In some cases, another treatment option may be recommended.
The most reliable way to understand your options is through an individualized psychiatric evaluation.
Discover Your Next Step With Phoenix Mental Health
If depression has continued despite treatment, you do not have to determine the next step by yourself.
Phoenix Mental Health offers advanced treatment options in both Seattle and San Antonio for eligible patients, including TMS and Spravato. A consultation can help clarify which treatments may be appropriate based on your symptoms, treatment history, health, and personal needs.
Contact Phoenix Mental Health to schedule a consultation at either location and receive a professional treatment recommendation.
This article is for general educational purposes and does not replace medical advice, diagnosis, or treatment. If you are experiencing a mental health emergency or are in immediate danger, call 911 or go to the nearest emergency department.
