Navigating depression can feel overwhelming, especially when traditional antidepressants do not bring the improvement someone hoped for. Many people try multiple medications and still experience symptoms that affect their daily life. In these moments, exploring additional mental health options can be an important step forward.

For adults in Pittsburgh and Southwestern Pennsylvania, New Directions Mental Health offers compassionate support and access to advanced depression treatment options when standard approaches are not enough. Select clinic locations provide NeuroStar® transcranial magnetic stimulation (TMS) and Spravato®, which may offer meaningful support for individuals living with difficult-to-treat depression.

Understanding treatment-resistant depression and alternative treatment options

Treatment-resistant depression (TRD) describes major depressive disorder (MDD) that does not improve after trying two or more antidepressant medications at appropriate doses. Some individuals may experience small changes in their depressive symptoms, but not enough to feel better in daily life. Others may have no noticeable response at all. This experience can be discouraging, especially when someone is trying to move forward in their mental health journey.

Traditional medications can be helpful for many people. However, depression treatment sometimes requires more than medication to help regulate mood, energy, and emotional well-being. Mental health providers assess depression severity by looking at symptom patterns, daily functioning, and emotional impact.

Severe depression may show up as:

• Persistent sadness
• Loss of interest in activities
• Trouble concentrating
• Overwhelming fatigue

When depressive symptoms continue despite multiple trials of medication, providers may discuss alternative treatment paths. The growing need for options has led to more interest in therapies such as TMS and Spravato®, both of which offer different ways of treating depression and supporting emotional wellness.

What is TMS?: An in-depth look at transcranial magnetic stimulation

Transcranial magnetic stimulation, also referred to as TMS, is a noninvasive treatment that uses focused magnetic pulses to stimulate nerve cells in areas of the brain involved in mood regulation. These brain regions can be less active in individuals with depression. TMS treatment works to stimulate these areas, potentially improving mood over time.

During a TMS treatment session, a magnetic coil is placed gently near the head. This coil delivers repeated magnetic pulses during each session. Many people report a tapping sensation on the scalp or mild discomfort where the coil is placed. Clients are awake and alert throughout the session and can immediately return to their daily activities.

A standard TMS treatment plan involves daily sessions over four to six weeks, with each session lasting about 20 to 40 minutes. Before beginning TMS, clients meet with a provider to talk through their goals, treatment history, and comfort level so they can decide on a plan that feels supportive and appropriate for their needs.

Research has shown that TMS treatment may help improve brain function linked to mood.¹ While individual responses vary, some people report gradual or noticeable improvement after several weeks. TMS is an FDA-cleared option for depression and is available at New Directions Mental Health locations. You can call 724.374.7414 to speak with a team member and find out which of our clinics offer TMS, as well as schedule a consultation.

What is Spravato®?: Exploring the nasal spray option for depression treatment

Spravato® is an FDA-approved esketamine nasal spray used to treat adults with treatment-resistant depression. It works differently from traditional oral antidepressants. Instead of targeting serotonin, Spravato® affects glutamate receptors, which play a role in mood regulation. Because of this unique mechanism, some individuals report feeling improvement sooner, though every experience is unique to the client.

Spravato® treatment visits take place in the clinic because a provider must monitor clients after they use the nasal spray. Each session involves self-administering the spray with provider guidance, followed by at least two hours of observation. During this time, providers check blood pressure and overall comfort, as temporary dizziness or dissociation can occur. Spravato® is taken along with an oral antidepressant.

Your provider will work with you to determine the number of weekly sessions and adjust your treatment plan as needed. While some individuals notice an improvement in their symptoms within hours or days, others may see changes over a longer period. You can call 724.374.7414 to connect with our team, learn which locations provide Spravato®, and schedule a consultation.

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Comparing TMS and Spravato®: Which treatment may fit your needs?

TMS and Spravato® provide valuable alternatives for clients looking for depression treatments beyond standard medications. They differ in how they work, how they are administered, and what clients may experience during treatment.

TMS is a device-based treatment that uses focused magnetic pulses to stimulate underactive areas of the brain involved in mood regulation. It does not require medication and is provided through a series of noninvasive in-office sessions. TMS is an FDA-cleared treatment for depression. The most common side effect is a mild headache, which often improves after the first week of treatment. Some clients also notice mild scalp discomfort or tapping sensations during sessions, and these effects typically lessen over time.

Spravato® is a nasal spray treatment that works through chemical pathways in the brain and often has a rapid onset of action. It requires clinical monitoring to observe changes in blood pressure and any temporary dissociation that may occur. Clients remain in the office after administration until they feel stable and secure.

Insurance coverage varies for both treatments. Many insurance plans cover TMS or Spravato® for adults diagnosed with treatment-resistant depression, although requirements differ across providers. Clients are encouraged to speak with their psychiatric provider about previous treatments, goals, and expectations when deciding which option may fit their mental health needs.

Choosing between TMS and Spravato® is a personal decision shaped by your goals, history, and what has or hasn’t worked before. Our providers at New Directions Mental Health take the time to listen, understand, and support you as you decide on the path that may help you move forward.

Treatment considerations: Safety, side effects, and what to expect

Understanding the safety profile and expectations of each treatment can help clients feel more comfortable and confident when exploring new treatment paths.

TMS considerations

• Sessions last 20 to 40 minutes
• Many clients feel mild scalp discomfort or muscle twitching during treatment
• TMS is not recommended for individuals with certain metal implants or medical devices near the head
• Some medications may require discussion with a provider before starting TMS, so an evaluation is important

Spravato® considerations

• Spravato® treatment requires monitoring due to possible temporary dizziness, dissociation, or increased blood pressure
• Clients cannot drive after treatment and must arrange transportation
• Some individuals experience mild discomfort during nasal spray administration
• Providers will review medications that should be avoided with Spravato®, as interactions vary

Common client questions addressed