Spravato vs. TMS: Which Is Right for You?

If antidepressants haven’t given you the relief you were hoping for, you’re not alone — and you’re not out of options. Two treatments that come up frequently for treatment-resistant depression are Spravato (esketamine) and TMS (Transcranial Magnetic Stimulation). Both have been reviewed by the FDA, both are covered by some insurance plans, and both offer real hope for people who haven’t responded to traditional medication. But they work in very different ways — and one may be a better fit for your life, your health, and your goals.

Here’s what you need to know about Spravato vs. TMS so you can make an informed decision about your care.

What Is Spravato?

Spravato is a nasal spray form of esketamine, a drug related to the anesthetic ketamine. The FDA approved it in 2019 for adults with treatment-resistant depression and major depressive disorder with suicidal ideation.

Because of how it works on the brain — targeting NMDA receptors rather than the serotonin system — Spravato can produce results more quickly than traditional antidepressants. Some patients notice improvement within hours or days.

How it’s administered: Spravato is given in a certified healthcare provider’s office. You self-administer the nasal spray under supervision and then must remain monitored for at least two hours due to risks of sedation, dissociation, and blood pressure changes. You cannot drive yourself home.

Typical schedule: Twice weekly for four weeks, then weekly for four weeks, then once weekly or once every two weeks as maintenance.

What Is TMS Therapy?

TMS (Transcranial Magnetic Stimulation) uses gentle magnetic pulses — similar to those in an MRI machine — to stimulate the area of the brain responsible for regulating mood. In people with depression, this region is often underactive. TMS helps reawaken those neural pathways over the course of treatment.

The FDA cleared TMS for treatment-resistant depression in 2008, making it one of the more established non-drug options available.

How it’s administered: You sit comfortably in a chair while the TMS device delivers painless magnetic pulses. No sedation is needed. Sessions typically run 19 minutes, and you can drive yourself to and from appointments and go about your normal day immediately after.

Typical schedule: Five sessions per week for six weeks.

Spravato vs. TMS: A Side-by-Side Comparison

	Spravato	TMS Therapy
FDA Status	Approved 2019	Cleared 2008
How It Works	Drug-based (esketamine nasal spray)	Non-drug, magnetic stimulation
Possible Side Effects	Dissociation, sedation, nausea, dizziness, blood pressure changes	Mild scalp discomfort, occasional headache (typically fades after week one)
After Treatment	Must be monitored 2+ hours; cannot drive	Drive yourself; resume normal activities immediately
Speed of Results	Can be rapid (hours to days)	Gradual improvement over weeks
Long-Term Relief	Requires ongoing maintenance doses	Many patients experience lasting relief after completing the initial course
Insurance Coverage	Some plans; criteria vary	Medicare, Tricare, VA ChampVA, Blue Cross Blue Shield, Aetna, Cigna, United, and all commercial insurance plans

Which Treatment Is Right for You?

The answer depends on your specific situation, medical history, and what matters most to you day to day.

Spravato may make sense if:

You’re in acute crisis and need faster symptom relief
Your provider has determined you meet the specific clinical criteria for esketamine treatment
You have someone who can drive you to and from each appointment

TMS may be the right fit if:

You want a treatment with no systemic side effects (TMS does not circulate through your bloodstream)
You need to stay fully alert and functional — at work, at home, or in a demanding role
You’re a veteran, active-duty service member, or military family member covered by Tricare or ChampVA
You prefer a proven, non-drug approach with a strong long-term track record
You want the ability to drive yourself to appointments and continue daily life without interruption

At Advantage TMS, we also combine our TMS and Spravato programs with cognitive behavioral therapy and lifestyle support — nutrition, mindfulness, fitness tracking, and free group therapy during and after treatment. This whole-person approach gives TMS and Spravato an added dimension that goes beyond what the technology and medication alone can offer.

What About Cost and Insurance?

Both Spravato and TMS require prior treatment with antidepressants before most insurance plans will approve coverage.

TMS tends to have broader insurance coverage at this point. Advantage TMS accepts all commercial and federal insurance plans, including Medicare, Tricare, ChampVA, all Blue Cross Blue Shield plans (including Florida Blue), United Healthcare, Aetna, Cigna, Evernorth, Optum, Oscar, and Beacon/Carillon. If you don’t see your plan listed, call us — we can often work out a single case agreement.

Self-pay options with financing are also available.

Talk to Someone Who Knows TMS

Choosing between Spravato vs. TMS is a personal decision, and the right answer depends on a full picture of your health history and goals. Our team — including our Licensed Clinical Social Worker and board-certified psychiatrist — is here to help you figure out what makes the most sense for you.

Same-day free consultations are available, and if TMS is the right fit, you can start treatment within 5–7 days of your consult. Spravato takes about 7-10 days to begin treatment. Contact us today to schedule a free consultation and find out if TMS or Spravato is right for you.

Dr. Katherine R. Rizzo

Dr. Katherine R. Rizzo is a board-certified psychiatrist specializing in TMS therapy and integrative psychiatry. Discover her holistic approach to treating depression, anxiety, OCD, and more at Advantage TMS.

Sources

Jewett BE, Thapa B. Physiology, NMDA Receptor. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519495/