Depression impacts all aspects of life, from work and relationships to sleep and daily routines. For many people, medications and therapy bring relief. But for others, depressive symptoms remain even after trying multiple treatments. This is known as treatment-resistant depression (TRD), and it often requires new approaches to care.

Two innovative treatments are making a difference for people with TRD: NeuroStar® transcranial magnetic stimulation (TMS) therapy and Spravato® nasal spray. Both are FDA-approved and available at select New Directions Mental Health locations in Pittsburgh and across southwestern Pennsylvania. By offering these mental health treatment options, our providers create personalized plans to help clients manage depression symptoms and take steps toward recovery.

Types of treatment options for treatment-resistant depression

Treatment-resistant depression is generally defined as depression that has not improved after trying at least two different antidepressants at the proper doses. People with TRD often continue to experience severe symptoms such as sadness, hopelessness, loss of energy, and difficulty with mood regulation.

Treatment plans for TRD may include:

• Transcranial magnetic stimulation (TMS): A noninvasive therapy that uses magnetic pulses to stimulate brain cells. This approach does not involve surgery or systemic medications.
• Spravato®: An FDA-approved nasal spray containing esketamine. It acts quickly on brain receptors that affect mood and may relieve depressive symptoms within hours or days.
• Therapy: Therapy helps people explore and change thought patterns, emotions, and behaviors.
• Psychiatry and medication: Psychiatric providers can diagnose and treat mental health diagnoses. They may prescribe medications that work on brain chemicals to alleviate symptoms.

Because every individual experiences depression differently, personalized treatment plans are essential. At New Directions Mental Health, providers carefully evaluate history, symptoms, and goals before recommending the best path forward.

TMS vs. Spravato®: Understanding the difference

Transcranial magnetic stimulation therapy

TMS therapy is noninvasive and FDA-approved for major depressive disorder. It works by delivering magnetic pulses to the dorsolateral prefrontal cortex, a part of the brain involved in mood regulation. In people with depression, this area often shows lower activity. TMS helps stimulate nerve cells and may improve communication between brain regions.

A typical TMS session at New Directions Mental Health lasts about 19-37 minutes. Treatments are usually scheduled for several weeks, with a typical plan often including 36 sessions. Your provider will have more insight into what may work best for you regarding the length and frequency of treatments.

Clients remain awake and alert, and many describe the sensation as light tapping on the scalp. Because there are no drugs involved, TMS is considered a drug-free treatment option. The most common side effects are mild scalp discomfort or headaches, often improving after the first week of treatment.

Spravato® treatment

Spravato® is an esketamine-based nasal spray approved by the FDA for treatment-resistant depression. Unlike oral antidepressants that act slowly, Spravato® works on different brain receptors and often produces rapid results. Some people report relief of depressive symptoms within hours or days.

Spravato® must be administered under medical supervision in a clinic. Clients self-administer the nasal spray, then remain under observation for about two hours. This monitoring is important because Spravato® can temporarily raise blood pressure and may cause dissociation or sedation. Spravato® is always used along with an oral antidepressant to support long-term stability.

View full prescribing information here.

Choosing the right treatment for you

Several factors influence the decision between TMS therapy and Spravato®. New Directions Mental Health providers work closely with clients to find the most appropriate approach.

Factors considered include:

• The severity of depression symptoms and how much they interfere with daily life.
• Past treatment history, including medications tried and their effects.
• Current medications and how they might interact with new treatments.
• Potential side effects and individual comfort with either a device-based or medication-based treatment.

Personalized treatment planning means clients receive care designed around their needs and goals. Some may respond best to TMS, while others may benefit from Spravato®, and a few may use these in combination with therapy or medication adjustments.

Benefits and possible side effects of TMS and Spravato®

Both TMS therapy and Spravato® provide options for those living with TRD, but they come with unique benefits and considerations.

TMS therapy:

• Noninvasive and medication-free
• Minimal side effects, usually mild discomfort on the scalp or temporary headaches
• Some people report light facial twitching during sessions, but these effects typically lessen over time

Spravato®:

• Provides fast relief of depressive symptoms for some clients
• Works on brain pathways not targeted by traditional antidepressants
• Possible side effects include dizziness, sedation, and temporary dissociation, which is why in-office monitoring is required

Neither treatment guarantees results for everyone, but many clients have found meaningful improvement when other approaches did not bring relief. At New Directions Mental Health, our providers help clients understand the risks and benefits before moving forward with either option.

Reach out to New Directions Mental Health for guidance in choosing TRD treatment

Exploring advanced treatments like TMS therapy and Spravato® can feel overwhelming, but you don’t have to make this decision alone. We take time to listen, answer questions, and recommend care that fits each client’s goals.

If you are struggling with treatment-resistant depression, call us at 724.374.7414 to discuss whether TMS therapy, Spravato®, or another depression treatment may be right for you.

For new clients, please click here to schedule an appointment. For existing clients, please click here and find your office location to contact your office directly.