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Spravato vs TMS is a common question for adults who have tried several antidepressants without enough relief. Both are used when depression has not responded to standard care, yet they work in very different ways. Spravato is a nasal spray made from esketamine. TMS stands for transcranial magnetic stimulation, a treatment that uses magnetic pulses. A little background can help you prepare for conversations with your provider.
This guide compares how each one works, what sessions involve, and which factors matter. It also helps to know what each option asks of you before a first appointment. You can also see how treatment-resistant depression care in Mesa is organized locally.
Many people start with a daily antidepressant. When symptoms stay after several adequate trials, providers look at other paths. An adequate trial means the right dose, taken as prescribed, for long enough to judge the result. Our article on why depression may not improve with medication explains how this point is reached.
At that stage, two options often come up. One is a medicine-based approach given in a clinic. The other is a device-based approach that does not use medicine at all. The Spravato vs TMS discussion is really a question about fit. Each has its own schedule, its own safety checks, and its own kind of commitment.
TMS uses a coil held against the head to send magnetic pulses to a targeted brain area. According to the National Institute of Mental Health (NIMH), the U.S. Food and Drug Administration (FDA) has cleared repetitive TMS, known as rTMS, for treatment-resistant depression. The page adds that rTMS does not require anesthesia, which is medicine that keeps you asleep during a procedure. It can be done in a clinic or office.
The pulses usually target the left prefrontal cortex, a region at the front of the brain that helps regulate mood. The same source describes standard courses as daily sessions, five days a week, for 4 to 6 weeks. Faster protocols may finish within a week.
Electroconvulsive therapy, or ECT, is a different brain stimulation option. It uses a brief electrical current under anesthesia and is usually considered after other treatments have not helped. The same page notes that rTMS does not match ECT’s effects, so providers weigh them separately.
TMS is noninvasive, meaning nothing enters the body. According to Mayo Clinic, you stay awake in a reclining chair and wear earplugs. The first visit takes about an hour, because the team maps the best coil position and the right strength. Later sessions use those settings.
The same source says sessions last either about 3.5 minutes with a shorter pattern or about 20 minutes with the standard pattern. The courses run for several weeks, as described above.
These effects are usually mild to moderate. They tend to ease soon after a session and often lessen with more sessions. Rare but serious effects include seizures, which are sudden bursts of abnormal brain activity. Mania can also occur, mainly in people with bipolar disorder. It means a period of unusually high energy and mood. Hearing loss can occur if the ears are not protected, which is why earplugs are used.
Esketamine does not use magnets. It is a nasal spray that affects the glutamate system, which is the brain’s main excitatory chemical messenger. According to Mayo Clinic, it is used in adults who have not improved after at least two prior antidepressants. It is available only through a restricted program called REMS, which stands for Risk Evaluation and Mitigation Strategy.
Each dose is given in a medical facility under supervision. The same source says staff check for drowsiness, changes in mental state, high blood pressure, and breathing problems for at least 2 hours afterward. Many people also continue an oral antidepressant, which is one taken by mouth. You can read what a visit is like in our article about what patients can expect during a Spravato session.
Putting the two side by side makes the contrast clearer. The Spravato vs TMS comparison comes down to how each works, how often you attend, and what safety checks apply.
Our page on Spravato treatment for treatment-resistant depression explains how this option is evaluated and delivered.
No single factor decides the choice. Providers look at your health history, your schedule, and your preferences together.
Your own priorities count too. Some people care most about avoiding medicine changes, while others want the fewest visits. In the Spravato vs TMS decision, there is no wrong preference. What matters is that you share it openly, so your provider can weigh it alongside your history and safety.
Depression has many forms, and our depression treatment page explains how each is evaluated before any plan is chosen.
Treatment is rarely a single decision. A person may try one approach, review the results, and then talk about another. Providers decide the order based on history, safety, and how symptoms change.
This is why records matter. Keep track of past medicines, doses, dates, and side effects. Note which treatments helped even a little. A clear history helps your provider avoid repeating what has not worked and spot what might fit next.
It also helps to track how you feel during any treatment. Short daily notes on mood, sleep, energy, and side effects give your provider real information at each review. Bring a family member or friend to appointments if that feels useful, since a second set of ears can help you remember details and questions.
No. Your provider reviews your history, your medicines, and your goals. The decision is shared, and it can change over time.
No. TMS uses magnetic pulses from a coil placed against the head. It does not involve a drug, though it still follows a medical schedule.
TMS does not use anesthesia, but you should still ask your provider about driving. After Spravato, you need a ride home and should not drive until the next day.
No. Responses vary for both. Some people improve, some improve partly, and some do not respond. Your provider will track progress and adjust.
It depends. TMS asks for short daily sessions over several weeks. Spravato asks for fewer visits after the first month, but each visit is longer.
Coverage differs by plan. Many plans ask for a record of earlier treatments that did not help. Contact your insurer and your provider’s office for details.
Neither option is better for everyone. One is a nasal spray given with careful monitoring. The other is a magnetic treatment given in short, frequent sessions. The right fit depends on your health, your routine, and how your depression has responded so far.
Before you decide, gather your treatment history and write down your questions. Understanding the Spravato vs TMS question is the first step, and your provider can help you take the next one.
Disclaimer: This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always speak with a qualified healthcare provider about your individual situation. If you are in crisis or having thoughts of harming yourself, contact your local emergency services or a crisis line right away.