Depression is a complex condition, with many people not finding relief even after trying multiple medications. We call this phenomenon difficult-to-treat depression. However, two emerging treatments, TMS and Spravato®, show promise for many people with this condition. While both treatments target the same concern, their approach, administration, and potential side effects are different.
If you’ve been dealing with depression and not finding relief from traditional medications, TMS or Spravato® could help you get back to the life you deserve.
Understanding Transcranial Magnetic Stimulation Therapy
TMS is a non-invasive, FDA-approved treatment that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation. The pulses are delivered through a coil placed on the client’s head, specifically targeting the prefrontal cortex.
The goal of TMS therapy is to improve symptoms of depression by increasing activity in these targeted brain regions, which are often underactive in people with depression. The procedure typically takes around 30 minutes and requires daily sessions for 4-6 weeks.
What Is Spravato®?
Spravato® is an FDA-approved, esketamine-based nasal spray medication that works by activating glutamate, a specific type of neurotransmitter in the brain that is involved in regulating mood and energy.
Unlike traditional antidepressants, which can take weeks to show results, Spravato® has been shown to have fast-acting effects, often providing relief within hours or days. It requires two hours of in-clinic supervision after administration to watch for side effects like changes in blood pressure or dissociation.
Which Is More Effective for Treating Depression Symptoms?
Studies show that both Spravato® and TMS can be incredibly effective at treating hard-to-treat depression, especially when compared to trying another medication. There are very few studies showing direct comparisons of the two treatment options, but initial research shows that TMS may have slightly lower risks of medical complications. However, esketamine (Spravato®) was slightly more impactful at relieving suicidal thoughts, especially during the first 30–90 days.¹²
What’s going to be most helpful for you will depend on a wealth of factors, so our care teams will take time to talk through all your current symptoms, history, and goals to help you decide which treatment option would be most appropriate.
If you are feeling suicidal or experiencing a mental health crisis, please reach out for immediate support by contacting your local emergency services, visiting your local emergency room, or calling/texting the National Crisis Hotline at 988.
Benefits & Possible Side Effects of TMS vs. Spravato®
TMS therapy is a non-invasive option with minimal side effects, ideal for those who prefer medication-free treatments. It focuses on brain stimulation and may have fewer lasting side effects than medications. Side effects from TMS are generally mild and resolve quickly, but might include a headache or pain at the treatment sight.
Spravato® is known for its fast action, providing quick relief from depressive symptoms. This can be crucial for people needing immediate relief from acute depression symptoms and suicidality. However, Spravato® may come with side effects such as dizziness, sedation, or feelings of dissociation.
Ultimately, it’s important to discuss your treatment options with a mental health professional who can evaluate your specific situation and recommend the most appropriate plan for you. At New Directions Mental Health, our team of compassionate providers will work closely with you to understand your needs and provide personalized care.
Choosing the Right Treatment for Your Needs
Different people may respond differently to TMS therapy and Spravato®, depending on their unique needs and preferences. Our care teams will help you decide which option will be most appropriate for your needs and give you the best chance at recovery.
TMS could be right for you if:
- You prefer a non-medication approach with few side effects
- You’re able to attend five sessions a week
- You want to be able to yourself drive home after treatments
Spravato® could be the proper choice if:
- You’re looking for fast-acting relief from severe symptoms
- You don’t want to go into a clinic more than twice a week
- You have someone who can drive you home from appointments
Reach Out to New Directions Mental Health for Comprehensive Depression Treatment
If you haven’t found relief from antidepressants, you’re not out of options, and we’re here to help you decide the right next step. At New Directions Mental Health, we offer TMS therapy and Spravato® services to help our neighbors in the Pittsburgh area recover from depression symptoms. Call 724.374.7414 or schedule your first appointment today.
Sources:
- Jen-Ping Chen, Chih-Wei Hsu, Yi-Ting Chen, Yi-Ya Fang, Ping-Tao Tseng, Mu-Hong Chen, Yu-Chen Kao, Tien-Wei Hsu, Chih-Sung Liang. (2026). Comparison of rTMS and esketamine for treatment-resistant depression: A target trial emulation. Journal of Affective Disorders 399(121132). https://doi.org/10.1016/j.jad.2025.121132
- Kaster, T. S., Dai, Y., Vila-Rodriguez, F., Downar, J., Daskalakis, Z. J., Blumberger, D. M., & Rhee, T. G. (2025). Efficacy of intranasal esketamine versus rTMS for treatment-resistant depression: analysis of individual participant data from two clinical trials. EClinicalMedicine, 90, 103609. https://doi.org/10.1016/j.eclinm.2025.103609
