Spravato®, Ketamine, or TMS: Which Treatment Might Be Right for Me?
When depression hasn't improved enough with traditional antidepressants or therapy, it can be frustrating to feel like you're running out of options.
The good news is that mental health treatment has evolved.
Today, treatments such as Spravato® (esketamine), ketamine infusion therapy, and transcranial magnetic stimulation (TMS) offer additional options for certain individuals who haven't found adequate relief with traditional approaches.
But with several choices available, one of the first questions we often hear is:
“Which treatment is right for me?”
The answer depends on your symptoms, diagnosis, treatment history, medical history, preferences, insurance coverage, and individual goals.
Here's a closer look at how these treatments differ.
What Is Spravato®?
Spravato® is the brand name for esketamine, an FDA-approved prescription nasal spray used for certain adults with depression.
Unlike traditional antidepressants, which primarily target neurotransmitter systems such as serotonin or norepinephrine, esketamine acts primarily through the brain's glutamate system and NMDA receptors.
Spravato® is administered in a certified healthcare setting, where patients are monitored for at least two hours after each treatment.
Spravato® May Be Worth Considering If:
You've tried antidepressant medications without adequate improvement
You have treatment-resistant depression
You prefer a non-IV treatment
Insurance coverage is an important consideration
You're able to commit to scheduled, monitored treatment visits
Treatment is typically more frequent at the beginning and gradually becomes less frequent depending on response and the treatment plan.
What Is Ketamine Infusion Therapy?
Ketamine has been used medically for decades and, at lower doses, is also used off-label in the treatment of certain mental health conditions.
For mental health treatment, ketamine can be administered through an IV infusion in a controlled clinical setting.
Like esketamine, ketamine affects the glutamate system rather than relying solely on the pathways targeted by traditional antidepressants.
One reason ketamine has generated so much interest is its potential for a more rapid antidepressant response in some individuals.
Ketamine May Be Worth Considering If:
Depression hasn't responded adequately to traditional treatments
A clinician determines ketamine is appropriate for your condition
You're interested in an IV treatment option
You prefer an option that isn't dependent on insurance authorization
Other symptoms or treatment goals make ketamine a reasonable consideration
Because IV ketamine for psychiatric conditions is generally an off-label treatment, insurance coverage is often limited, and patients may need to pay out of pocket.
What Is TMS?
Transcranial magnetic stimulation, or TMS, takes a very different approach.
Instead of administering medication, TMS uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation.
At Journey to Wellness, we offer Exomind™ TMS, a noninvasive treatment that doesn't require an IV, nasal medication, anesthesia, or sedation.
During treatment, you remain awake and alert.
TMS May Be Worth Considering If:
Antidepressants haven't provided enough relief
Medication side effects have been difficult to tolerate
You'd prefer a non-medication treatment
You want to avoid treatments that cause temporary intoxication or require post-treatment monitoring
You're able to commit to a series of treatment sessions
Because there is no sedation, patients can generally return to their normal daily activities after treatment.
How Are Spravato®, Ketamine, and TMS Different?
Although all three may be considered when traditional approaches haven't been enough, the treatment experience is quite different.
Spravato® is a prescription nasal spray administered under medical supervision.
Ketamine infusion therapy involves receiving ketamine intravenously while being monitored in a clinical setting.
TMS doesn't involve medication at all. Instead, magnetic stimulation is used to target specific areas of the brain.
Another important difference is what happens after treatment.
Spravato® requires a monitoring period following each treatment, and patients cannot drive themselves home afterward.
Ketamine also requires monitoring, and patients need transportation home after treatment.
With TMS, there is generally no sedation or altered state requiring a recovery period, allowing patients to return to their usual activities afterward.
Which Treatment Works the Fastest?
This is an understandable question, especially when you've been struggling for a long time.
Ketamine and Spravato® may produce improvement relatively quickly in some patients, sometimes earlier than is typical with conventional antidepressants.
TMS usually works more gradually over a series of treatments.
But faster doesn't automatically mean better for every person.
The best treatment is the one that is appropriate for your diagnosis, medical history, previous treatments, lifestyle, and individual needs—and that provides meaningful, sustainable improvement.
Can Insurance Help Pay for Treatment?
Coverage varies significantly between treatments and insurance plans.
Spravato® may be covered by insurance for patients who meet specific medical criteria, although prior authorization is often required.
Coverage for TMS depends on the specific treatment, diagnosis, insurance plan, and medical-necessity requirements.
IV ketamine for psychiatric conditions is typically an off-label treatment and is often self-pay.
Our team can help you better understand what questions to ask your insurance company and what treatment options may be available to you.
What If I've Already Tried Several Antidepressants?
Trying medication after medication without getting the improvement you hoped for can be discouraging.
But an inadequate response to traditional antidepressants doesn't necessarily mean that nothing will work.
It may mean it's time to consider a different approach.
Spravato®, ketamine, and TMS work differently from conventional antidepressant medications and may provide additional options for appropriately selected patients.
How Do I Know Which One Is Right for Me?
You don't need to figure that out by yourself.
A mental health evaluation can help determine which treatment options make sense based on factors such as:
Your diagnosis and current symptoms
Medications you've already tried
How you responded to previous treatments
Medication side effects
Other medical conditions
Current medications
Your treatment goals
Your schedule and ability to attend treatments
Insurance coverage and cost
Your personal preferences
For some patients, one option is clearly more appropriate than the others. For others, there may be several reasonable approaches to consider.
There Are More Options Than Another Antidepressant
If you've struggled with depression despite trying traditional treatments, it can be easy to assume that the next step is simply another medication.
That isn't always the case.
Modern mental health care offers additional ways to approach difficult-to-treat depression.
At Journey to Wellness, we offer Spravato®, ketamine infusion therapy, and Exomind™ TMS along with psychiatric evaluation, medication management, and counseling. This allows us to look at the bigger picture and help determine which approach may best fit your individual needs.
You haven't necessarily run out of options.
You may simply need a different one.
Ready to Explore Your Options?
If depression hasn't improved enough with traditional treatment, we're here to help you understand what may come next.
