If several antidepressants have not helped enough, it is natural to feel stuck and unsure what else to try. You may hear about advanced options like TMS therapy and Spravato but not know how they compare, or which one might make sense for you. Both are used for treatment-resistant depression (TRD), yet they work in different ways and follow different treatment routines.
Understanding the basic differences between TMS therapy and Spravato can make conversations with your clinician feel clearer and less overwhelming. Instead of choosing based on a name or a quick headline, you can ask more focused questions about what each approach would look like in your own life.
TMS therapy is a non-invasive brain-stimulation treatment. During a session, a small coil rests on your scalp and delivers repeated magnetic pulses to areas of the brain that help regulate mood. Over time, these pulses are intended to nudge underactive mood circuits toward healthier patterns of activity.
Treatment happens entirely in an outpatient setting. You stay awake, there is no anesthesia, and sessions are usually brief. Many people are able to go back to work, school, or home routines soon after each appointment. A typical course involves several sessions per week over a number of weeks, with your progress and comfort monitored along the way.
TMS therapy is often combined with talk therapy and thoughtful medication management. The aim is not to replace all other care, but to add another tool for TRD while you continue other helpful support.
Spravato (esketamine) is a prescription nasal spray used for adults with TRD and, in some cases, adults with major depressive disorder and acute suicidal thoughts or behavior. It is always used along with an oral antidepressant. Unlike most standard antidepressants, Spravato acts on glutamate pathways, offering a different route to influence mood and thinking.
Spravato is given only in a certified clinic. At each visit, you self-administer the nasal spray under supervision, then stay for a period of observation. During that time, staff monitor your blood pressure, level of alertness, and any short-term changes in perception. Because these effects can make it unsafe to drive, you arrange a ride home after each session and plan for a quieter day afterward.
This structure is part of a national safety program and is built into how Spravato is prescribed. It also means your clinician can track your response closely and adjust your treatment plan as needed.
Although both options are used when depression has not responded to several medications, they differ in important ways. Thinking through these contrasts with your clinician can help you decide which one better fits your needs and daily life.
These differences shape how each treatment fits into work schedules, family responsibilities, transportation, and comfort with either device-based or medication-based options. They also guide how your clinician evaluates medical factors, such as blood pressure, other diagnoses, and past responses to care.
Understanding the differences between TMS therapy and Spravato is not something you need to do alone. Our providers can review what you have already tried, any side effects, and what you hope will change, then walk you through how each option works and what to expect. Call us to learn more about which treatment may be right for you.