How TMS and Spravato compare
| Topic | TMS | Spravato |
|---|---|---|
| Treatment approach | Magnetic stimulation delivered through a coil positioned near the head | Prescription intranasal esketamine administered under healthcare supervision |
| Eligibility | Depends on the specific device, protocol, diagnosis and treatment history | Depends on the approved depression indication and an individual safety assessment |
| Visit commitment | Stimulation time and course length depend on the protocol; many courses involve repeated visits over several weeks | Allow time for dosing and at least two hours of monitoring afterward; some visits take longer. Your clinician decides when you are ready to leave. |
| After the visit | Usually no sedation; discuss any symptoms or individual restrictions with the team | Arrange a ride home. Do not drive or operate machinery until the next day after a restful sleep. |
| Important risks | Scalp discomfort or headache; rare serious risks including seizure; device-specific screening matters. See TMS side effects. | Important risks include sedation, dissociation, respiratory depression, increased blood pressure, abuse and misuse, and the boxed warning addresses suicidal thoughts and behaviors. This is a short summary; read the full prescribing information, including the boxed warning. |
| Cost | Depends on protocol, session count, insurance and follow-up. See TMS cost. | Depends on medication and administration coverage, monitoring and plan requirements. See insurance coverage. |
Treatment approach
TMS: Magnetic stimulation delivered through a coil positioned near the head
Spravato: Prescription intranasal esketamine administered under healthcare supervision
Eligibility
TMS: Depends on the specific device, protocol, diagnosis and treatment history
Spravato: Depends on the approved depression indication and an individual safety assessment
Visit commitment
TMS: Stimulation time and course length depend on the protocol; many courses involve repeated visits over several weeks
Spravato: Allow time for dosing and at least two hours of monitoring afterward; some visits take longer. Your clinician decides when you are ready to leave.
After the visit
TMS: Usually no sedation; discuss any symptoms or individual restrictions with the team
Spravato: Arrange a ride home. Do not drive or operate machinery until the next day after a restful sleep.
Important risks
TMS: Scalp discomfort or headache; rare serious risks including seizure; device-specific screening matters. See TMS side effects.
Spravato: Important risks include sedation, dissociation, respiratory depression, increased blood pressure, abuse and misuse, and the boxed warning addresses suicidal thoughts and behaviors. This is a short summary; read the full prescribing information, including the boxed warning.
Cost
TMS: Depends on protocol, session count, insurance and follow-up. See TMS cost.
Spravato: Depends on medication and administration coverage, monitoring and plan requirements. See insurance coverage.
Which works better?
Both treatments have supporting evidence for specific depression populations. Recent comparisons include observational studies and indirect analyses of different trials. Differences in patient selection, protocol and measurement limit a simple winner-versus-loser conclusion. A percentage from one study should not be treated as your personal chance of success or compared directly with an unrelated study.
Read the comparative evidence: comparative TMS and esketamine evidence (PubMed) and comparative TMS and esketamine evidence (PubMed Central). For TMS results in context, see our TMS success rate page.
What should I ask at my evaluation?
- Which diagnosis and indication are we treating?
- What previous treatments and safety factors affect my options?
- What is the expected visit schedule and how will progress be measured?
- What costs are included, and what requires insurance authorization?
- What are the follow-up options if I improve or do not improve enough?
What if the first option does not help enough?
Your psychiatrist can reassess the diagnosis, treatment response, tolerability and practical barriers, then discuss a different or additional treatment plan. There is no universal sequence or combination that guarantees the best result.
Learn more about each option
Read about TMS therapy and Spravato at our clinic, then bring your questions to your visit.
If you are in immediate crisis, call 988 (Suicide & Crisis Lifeline) or 911.
Sources and further reading
- SPRAVATO (esketamine hydrochloride) nasal spray, current label. DailyMed / U.S. National Library of Medicine
- Comparative evidence on TMS and esketamine for depression (observational and indirect analyses). PubMed
- Comparative evidence on TMS and esketamine for depression (full text). PubMed Central
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.