Depression can impact nearly every aspect of your life and affect your mood, relationships, and daily functioning. While many people with depression respond well to treatment with antidepressants and with talk therapy, some individuals struggle with treatment-resistant depression that shows little response to traditional therapeutic methods.
If you struggle with depression and find little to no relief from your antidepressants and therapy regimen, you might benefit from a combination of transcranial magnetic stimulation (TMS) and Spravato (esketamine nasal spray). These treatments work differently from other depression treatments and medications by targeting different areas of the brain. At Oasis Mental Health Centers in New Jersey, our compassionate professionals have written this guide about TMS and Spravato to help you understand these treatments and how they might help you.
What Are Transcranial Magnetic Stimulation (TMS) and Spravato?
Transcranial magnetic stimulation (TMS) is a noninvasive treatment for depression that is performed on an outpatient basis. It uses magnetic fields to target and activate specific areas of the brain that medication doesn’t always reach.
When you undergo this procedure, a magnetic coil will be placed over your head to transmit magnetic pulses to the targeted areas of your brain. The pulses will stimulate the neurons in the desired region to send electrical signals and potentially improve functioning. TMS is approved by the US Food and Drug Administration (FDA) for the treatment of depression and obsessive-compulsive disorder (OCD).
Spravato is the name brand for S-ketamine, an isomer of ketamine known as esketamine. It is a nasal spray that is administered in a clinical setting to people suffering from treatment-resistant depression. Esketamine is a synthetic isomer of ketamine, which has been used as an anesthetic during surgery for decades. Doctors and researchers noticed that ketamine also relieves the symptoms of depression and anxiety, which subsequently led researchers to investigate its use for those purposes.
Spravato targets glutamate receptors in your brain to improve communication. Depression interferes with the communication from these receptors and inhibits it. The FDA approved Spravato for treatment-resistant depression in 2019 when used in combination with other antidepressants. In January 2025, the FDA expanded its approval to allow Spravato to be used without other antidepressant medications. It can only be administered in approved and certified facilities under observation. Once you receive it, you will be supervised for a few hours to watch for any possible side effects.
What Are the Side Effects of TMS and Spravato?
TMS is considered a very safe treatment with few side effects. When you undergo TMS, you might experience the following:
- Tingling sensation
- Slight discomfort from the placement of electrodes
- Headache
These side effects are uncommon and typically subside after a few sessions for people who experience them. TMS can be used by most people except those with seizure disorders.
Spravato has several side effects your practitioner will watch for, including:
- Dissociation
- Drowsiness
- Numbness
- Nausea and vomiting
- Dizziness
- Increased blood pressure and heart rate
- Headache
- Fatigue
Because of its side effects and addictive potential, Spravato can only be administered in FDA-approved clinics. It’s not appropriate for pregnant women, people with high blood pressure, those with a history of brain bleeds, or other conditions.
How TMS and Spravato Relieve Treatment-Resistant Depression
TMS stimulates nerve cells in the dorsal prefrontal cortex. This brain region is known to be underactive in people who suffer from depression. The magnetic pulses released during a TMS session activate the neurons in this region to improve communication. Over a few weeks of TMS, your symptoms might improve significantly.
Spravato is used as a nasal spray and targets glutamate receptors in the neural synapses in your brain. This spurs your brain to produce and release glutamate, grow new connections, and improve mood. Spravato is fast-acting and can improve your mood within a few hours to days for quick relief of severe symptoms.
Can TMS and Spravato Be Combined?
TMS and Spravato can be used together for increased efficacy and relief. Since they work on different areas of the brain through different pathways, the combination provides a more comprehensive impact.
The combination of these two treatments also provides both rapid relief and long-term improvements. Spravato is fast-acting while TMS leads to long-term relief. Dual treatment with Spravato and TMS also helps improve the outcomes for those suffering from treatment-resistant depression.
People who might benefit from a combined treatment using both TMS and Spravato include those whose depression hasn’t responded to other antidepressants or therapy. This includes those who have severe depression with suicidal ideations. Similarly, those who also experience anxiety with depression might find the combined treatment more effective than monotherapies.
Frequency of Treatment Sessions
Spravato is typically administered two times per week during the first four weeks and then once weekly or every other week. It can eventually be tapered down over time. TMS is typically administered five times per week in your clinician’s office over four to six weeks. Since TMS has few side effects, it can be safely combined with Spravato or other depression treatments.
Talk to Our Caring Professionals
If you struggle with chronic depression that has failed to respond to talk therapy and traditional antidepressants, TMS and/or Spravato might provide the relief that you’re looking for. Talk to our experienced, compassionate professionals at Oasis Mental Health Centers in New Jersey today to learn more about the right approach for treating your depressive symptoms.
References:
https://www.jnj.com/media-center/press-releases/spravato-esketamine-approved-in-the-u-s-as-the-first-and-only-monotherapy-for-adults-with-treatment-resistant-depression
