Comparing Spravato and TMS Therapy for Treatment-Resistant Depression

When Depression Needs a Different Approach 

When depression continues even after trying therapy, medication, or lifestyle changes, it can feel discouraging to wonder what comes next. For people living with treatment-resistant depression, finding the right path forward sometimes means looking beyond traditional treatments.

Two options that often come up in that search are Spravato and TMS therapy. While both are used to treat depression that has not improved with standard care, they work in very different ways and offer unique experiences for patients.

Understanding those differences can make deciding between treatments feel less overwhelming. In this blog, we’ll compare how Spravato and TMS work, what treatment looks like, and common questions about cost, timing, and long-term results so you can better understand the options available.

What Is Spravato?

Spravato is an FDA-approved nasal spray used to treat adults with treatment-resistant depression. It contains esketamine, a medication that works differently from traditional antidepressants. 

The medication is given in a certified medical office under supervision, where patients are monitored afterward for safety. Spravato is approved as a monotherapy, but it can also be prescribed alongside an oral antidepressant. This allows Spravato to become part of a broader treatment plan designed to support long-term symptom improvement.

How Does Spravato Work? 

While most antidepressants affect serotonin or similar brain chemicals, Spravato targets the brain’s glutamate system, which plays an important role in mood, learning, and communication between brain cells.

Because of this different mechanism, Spravato treatment may help some people who have not responded to standard medications alone. 

What Is TMS Therapy? 

Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-approved treatment for depression that uses gentle magnetic pulses to stimulate areas of the brain involved in mood regulation. 

Sessions are performed in an outpatient setting, and most people can return to their normal routine immediately afterward. 

In addition to depression, TMS may also help some individuals experiencing anxiety symptoms or obsessive-compulsive disorder as part of a personalized treatment plan.

How Does TMS Therapy Work? 

During TMS therapy sessions, a device is placed against the scalp to deliver targeted stimulation to underactive brain regions linked to depressive symptoms. Unlike medication-based treatments, TMS does not involve drugs, sedation, or anesthesia.

How Treatment Experience Differs 

Although both treatments are designed to help with depression, the day-to-day experience can feel quite different.

What Does Spravato Treatment Feel Like?

With Spravato treatment, the medication is given as a nasal spray in a certified clinic. Patients self-administer the spray under medical supervision and then remain in the office for monitoring afterward. 

Because Spravato can cause temporary dizziness, drowsiness, or a sense of feeling detached, patients cannot drive themselves home the same day. Many describe the experience as calm or slightly disorienting at first, with staff nearby throughout the entire visit.

What Does TMS Therapy Feel Like?

During the TMS treatment experience, patients sit comfortably in a chair while magnetic pulses are applied to the scalp by a trained provider. Some people notice a tapping sensation or mild discomfort during the session. 

Unlike Spravato, TMS does not require a recovery period, and most people can return to normal activities immediately afterward.

How Long It Takes to Notice Results 

One of the most common questions patients ask is how quickly these treatments begin to work. It’s important to remember that every brain responds differently to treatment.

Some people notice changes sooner, while others need patience and time. Setting realistic expectations can make the treatment journey feel a little less like waiting for lightning and more like watching a sunrise.

How Long Does it Take for Spravato to Work? 

For Spravato, some individuals notice improvement within the first few weeks, while others need more time before changes become noticeable.

How Long Does it Take for TMS Therapy to Work?

TMS typically works more gradually. Most people attend regular sessions over several weeks, and improvement often builds slowly as treatment continues. Because TMS relies on repeated stimulation, consistency plays an important role in the process.

How Long Benefits May Last 

Another common question about these treatments is whether the benefits will last long-term. Both treatments involve ongoing care that depends on how depression responds. Because no two experiences are exactly alike, long-term treatment plans are usually tailored to each person’s needs.

How Long Does Spravato Last?

For some people undergoing Spravato treatment, symptom relief can continue between scheduled visits. However, many patients need a maintenance plan to help sustain improvement over time. 

After the initial treatment phase, Spravato sessions are often spaced farther apart based on individual progress.

How Long Does TMS Therapy Last?

With TMS, treatment usually occurs over a 4-6 week period, and some people experience symptom relief that lasts for several months after completing treatment. In certain cases, booster sessions may be recommended if symptoms begin to return. 

Cost and Insurance Considerations 

Cost and insurance coverage is often an important part of comparing treatment options. Because pricing and benefits can vary widely for these treatments, the best way to understand your options is to verify details directly with your insurance and mental health provider.

Our team at Advanced Psychiatry can often help navigate both insurance coverage for TMS and Spravato approval requirements. 

How Much Does Spravato Cost? 

The answer can vary depending on dosage, treatment frequency, and insurance coverage. In many cases, insurance may help cover Spravato when prior authorization is approved and treatment-resistant depression criteria are met.

How Much Does TMS Therapy Cost?

TMS is also covered by many insurance plans, though providers often require documentation showing that other depression treatments were not effective first. Coverage can depend on the insurance company and the specific treatment protocol being used.

Who Might Benefit from Each Option? 

While both treatments can help with treatment-resistant depression, they may appeal to different people based on individual needs and preferences.

Spravato may appeal to people who:

• Prefer a medication-based treatment approach

• Have severe depression symptoms that have not improved with standard antidepressants

• Need additional support alongside existing medication

  
  

TMS may appeal to people who:

• Prefer a non-medication treatment option

• Want to avoid systemic side effects that can come with antidepressants

• Need a treatment that fits into daily life without recovery time afterward

  
  

Neither treatment is universally better than the other. The most appropriate option depends on your symptoms, medical history, and treatment goals, which is why a provider evaluation is such an important part of the decision.

How Advanced Psychiatry Helps Patients Explore Options 

At Advanced Psychiatry, we support our patients through every step of exploring treatment-resistant depression options. Care begins with a thorough psychiatric evaluation to better understand symptoms, treatment history, and individual goals.

From there, our providers may recommend services such as:

• Spravato treatment

• TMS therapy

• Psychotherapy

• Medication management

• Ongoing psychiatric support

  
  

Rather than rushing decisions, the focus is on education and collaboration. You will always have the opportunity to ask questions, understand your options, and work closely with our team to create a treatment plan that feels informed and personalized.

Conclusion

Both Spravato and TMS can offer hope for people living with treatment-resistant depression, but they work in very different ways. One uses medication to support brain chemistry, while the other uses magnetic stimulation to target mood-related brain activity.

Because depression treatment is deeply personal, choosing the right option is about finding what fits the best for you rather than finding a “better” treatment. Asking questions and learning about your options can be an important first step. 

With thoughtful guidance, meaningful and lasting relief from depression may be closer than it feels right now.

Advanced Psychiatry is Here to Help You

At Advanced Psychiatry, we are here to answer your questions, walk you through the process, and support you every step of the way. We provide authentic and trusted treatment options for depression, PTSD, anxiety, and OCD to those in the Fort Wayne, Ann Arbor, Lansing, and Troy communities. 

If you are considering depression treatment, please reach out to schedule a consultation and learn more about how we can help you on your journey toward healing.