Spravato vs TMS: Which is more effective against treatment-resistant depression (TRD)?
For adults 18 years and older who are struggling with TRD, major depressive disorder (MDD), and even anxiety or post-traumatic stress disorder (PTSD), Spravato® (esketamine) and transcranial magnetic stimulation (TMS) both offer hope when traditional antidepressants have failed.
However, each treat these conditions in very different ways, making them better suited for different patients. Here’s how each one works and how they are used by Pacific Mind Health providers.
What is Spravato?
Spravato, also known as esketamine, is a close relative of ketamine, an anesthetic used in surgery that has been found to rapidly relieve symptoms of TRD or depression with suicidal thoughts.
Administered as a nasal spray under medical supervision, Spravato targets the brain’s glutamate system, helping it to form new neural connections and improve mood regulation.
Approved by the Food and Drug Administration (FDA,) Spravato can provide fast relief, with some people feeling positive effects within hours or days. Typically used in conjunction with antidepressant medication, studies show that Spravato reduced the risk of relapse by 51% in patients who achieved stable remission.
Treatments are self-administered at Pacific Mind Health’s clinics, typically twice a week for the first month and then gradually taper off after that. Some patients may experience a dreamy, disconnected feeling called dissociation. Clients are monitored for about two hours after each dose to observe side effects and provide support as needed.
Many patients report reduced symptoms of depression, with results lasting up to 4.5 years when combined with ongoing intermittent treatments. Many also report improvements with sleep, concentration, and overall well-being and function.
What is TMS?
Transcranial magnetic stimulation (TMS) is a non-invasive FDA-cleared treatment that does not require anesthesia.
During a TMS session, a small device is placed on a patient’s head to deliver magnetic pulses to stimulate the parts of the brain that control mood. The treatment is not painful, but patients may feel a light tapping sensation on their heads.
A typical treatment protocol involves 20-minute treatments five days a week over the course of several weeks. There is no sedation and no recovery time needed. Patients can drive to and from appointments and resume regular activities when done.
Many patients begin to notice improvement after a couple of weeks, with full benefits often happening over time. In one study, 58% of patients experienced significant improvement of their depression symptoms, with 37% experiencing complete remission.
How are Spravato and TMS different?
While Spravato and TMS both used to treat TRD, MDD, and other conditions, they are very different in how they work and are administered. In general, Spravato is a form of medication, while TMS is a device-based therapy.
Spravato targets chemicals in the brain and requires longer visits. Patients are not permitted to drive or operate heavy machinery after treatment and are encouraged to rest the remainder of the day.
On the other hand, TMS does not involve any medication. Side effects are temporary and mild and can include a headache or slight scalp discomfort. Appointments are typically shorter and more frequent, and patients can drive and resume their regular activities when done.
Spravato vs. TMS: Which one is right for me?
Depression doesn’t always respond to the first — or even the fifth — medication. Everyone is different.
When traditional treatments or medications fall short, Pacific Mind Health providers work with patients to find alternative treatment options.
Providers may use pharmacogenomic testing, a genetic test that helps identify how a person’s DNA may affect their response to specific medications, including antidepressants.
Providers take the time to get to know the whole person when developing a treatment plan. They consider several factors when deciding whether Spravato or TMS is a better fit. These include:
- Symptoms: Spravato may be prioritized if patients experience acute suicidal ideation requiring rapid relief. TMS may be preferred for patients with chronic yet less-urgent depression or for those who need a non-medication approach.
- Treatment history: Patients who suffer side effects from medications might react better to TMS, which is drug-free. Spravato may be recommended for patients who have not responded to other medications.
- Medial history: Comorbidities such as high blood pressure and substance use history may influence a provider’s treatment recommendation. TMS, for example, has fewer side effects, making it more suitable for certain patients.
- Lifestyle considerations: Spravato sessions are less frequent but last longer because they require an observation period. Patients cannot drive afterward and are encouraged to rest the remainder of the day. TMS treatment, on the other hand, is more frequent but shorter. Patients can drive to and from appointments and resume normal activities afterward.
- Patient preference: Providers will always work with the patient to find a treatment that considers their comfort with medications and tolerance for side effects as well as their treatment goals. A shared decision-making process is essential.
What’s it like getting care at Pacific Mind Health?
One of the best ways to find out which treatment is right is to schedule a free consultation and talk with Pacific Mind Health’s care team.
The care at Pacific Mind Health goes beyond treatment to understand the full picture of an individual’s mental health. We offer compassionate, personalized support in a welcoming environment.
Whether you are comparing Spravato vs TMS or considering other options, we provide patients with a thoughtful evaluation, clear information, and a treatment plan tailored to meet their needs and goals.
There’s no waitlist, and our team helps with navigating the insurance process. Wherever you are in your journey, we’re here to help you take the next step with confidence.
Key Takeaways
- Spravato and TMS are both effective for treatment-resistant depression but work through very different methods: medication vs. brain stimulation.
- Spravato may be preferred for rapid relief, especially in cases involving suicidal thoughts, while TMS offers a non-medication alternative.
- Spravato is FDA-approved while TMS is FDA-cleared for adults. Both have shown strong results when traditional antidepressants haven’t worked.
- Spravato requires clinic monitoring and downtime, while TMS allows patients to resume daily activities immediately after each session.
- Pacific Mind Health offers personalized care, considering an individual’s full medical history, preferences, and lifestyle when recommending treatment.
Looking for mental health care services near you?
Pacific Mind Health offers medication management, therapy, and interventional treatments like transcranial magnetic stimulation (TMS) and ketamine and Spravato (esketamine). Our experienced clinicians provide compassionate, evidence-based care to help you feel better.
Ready to take the next step? Schedule a free consultation and start your mental health journey today.
