If your doctor has raised both TMS and Spravato, or you have read about them and cannot tell them apart, this comparison is for you. Both are established, FDA-recognized options for depression that has not responded to standard antidepressants. They work in very different ways, and the day-to-day experience of each is different too. Which one fits is a decision for you and a clinician, but knowing how they compare makes that conversation much easier.
How each one works
TMS (transcranial magnetic stimulation) uses focused magnetic pulses, similar in strength to an MRI, to stimulate areas of the brain involved in mood regulation. Nothing enters your body, and there is no sedation. It is a physical, drug-free approach to nudging brain activity in regions linked to depression.
Spravato (esketamine) is a medication derived from ketamine, delivered as a nasal spray. It acts on brain pathways that most oral antidepressants do not target, which is part of why it can help some people when earlier medications have not. It is used together with an oral antidepressant.
What a visit is actually like
With TMS, you sit in a chair, fully awake, while a device positioned near your head delivers pulses. A session is short, you can read or talk, and afterward you drive yourself home and go about your day. Treatment is a course of repeated sessions over several weeks.
With Spravato, you take the nasal spray at a certified clinic and are then monitored on-site for a period before you leave, because of how the medication can affect you shortly after a dose. You arrange a ride home rather than driving yourself. Visits follow a schedule set by your clinician.
Which tends to fit whom
There is no universal winner, and many clinics offer both so the choice can be tailored. In general:
- TMS often appeals to people who want to avoid adding another medication, who prefer to drive themselves and keep their day uninterrupted, or who have not tolerated drug side effects well.
- Spravato often fits people who are staying on an oral antidepressant and want to add a mechanism that works differently, and who can arrange monitored clinic visits with a ride home.
Both are meant for treatment-resistant depression, so if you are earlier in your journey, therapy and first-line medication usually come first. Our guide to treatment-resistant depression explains when these advanced options come into play, and the treatment types overview covers the full menu.
Questions to bring to a clinician
Ask which one they would recommend for your specific history and why. Ask what the schedule and time commitment look like, what your insurance covers, and what they would do if the first choice does not help enough. A good provider will be candid that neither is a guaranteed fix and that response varies from person to person.