Whether you choose transcranial magnetic stimulation (TMS) or Spravato (esketamine nasal spray), the efficacy of the treatment depends on the diagnosis, how treatment-resistant the depression is, and how well the person completes the full protocol.
What Is TMS Therapy and How Does It Treat Depression?
Transcranial magnetic stimulation, or TMS, is a non-invasive brain stimulation treatment cleared by the FDA for major depressive disorder. It uses precisely targeted magnetic pulses to stimulate the prefrontal cortex.
Because depression is closely linked to underactivity in this region, TMS essentially wakes those circuits back up over a course of repeated sessions.
At Boston Neurobehavioral Associates, we follow a standard TMS protocol. It runs five days a week for six weeks. Each session lasts 20 to 40 minutes. You sit in a chair, a magnetic coil is placed against your scalp, and the device delivers rhythmic pulses. There is no sedation or surgery involved in TMS therapy, and you can immediately drive and go home.
TMS is particularly effective for people who have not responded well to antidepressants or therapy alone.
Common conditions treated with TMS include:
Major depressive disorder (MDD)
Treatment-resistant depression
Social anxiety disorder
Smoking cessation (certain protocols)
What Is Spravato (Esketamine)?
Spravato is a prescription nasal spray containing esketamine. It is used for adults with treatment-resistant depression and, in some cases, major depressive disorder. It is administered under medical supervision.
Spravato treatment is administered at Boston Neurobehavioral Associates with proper care.
You inhale the nasal spray under supervision, then remain monitored for at least two hours before you can leave. You cannot drive on the same day you receive Spravato. The treatment schedule begins with twice-weekly sessions for four weeks, then tapers to weekly and monthly doses.
TMS vs. Spravato: Key Differences That Actually Change the Decision
What really drives the choice between these two treatments comes down to these factors.
How Quickly Do You Need Relief?
If you or someone you love is in acute distress, with depression that has become debilitating or involves thoughts of self-harm, Spravato's ability to produce relief within hours makes it a medically important option. TMS, by comparison, builds its effect gradually. Many patients report meaningful improvement around week two or three.
What Has Already Been Tried?
Both treatments are typically recommended after antidepressants have not produced adequate results. However, Spravato has specific FDA approval for treatment-resistant depression, defined as inadequate response to at least two antidepressants. TMS is approved for MDD broadly but is most often prescribed after at least one antidepressant fails.
What Does Your Daily Life Allow?
TMS sessions are shorter and leave you free to drive and work. Spravato sessions consume most of a morning or afternoon, require a designated driver, and happen more frequently in the induction phase. If you have a demanding job or caregiving responsibilities, the logistics of Spravato can be a real barrier.
Choosing Between TMS and Spravato: Who Each Treatment Is Right For
Choose TMS if you:
Prefer a non-medication, non-systemic approach
Want minimal side effects and no post-treatment downtime
Can commit to daily sessions for several weeks
Want potentially longer-lasting relief without ongoing medication
Choose Spravato if you:
Need rapid relief (acute suicidality, severe crisis)
Haven't responded to multiple medications
Can handle dissociative effects and have reliable transportation
Are already on an oral antidepressant (required for Spravato)
Can TMS and Spravato Be Used at the Same Time?
Yes, you can get TMS and Spravato treatment together, but only under the direction of a psychiatrist or interventional mental health team. For some patients, the combination is used when one treatment alone has not been enough.
Main cautions:
More clinic coordination required.
Spravato can cause sedation, dizziness, and dissociation.
Spravato can raise blood pressure temporarily.
Seizure risk screening for TMS.
Get TMS Therapy and Spravato Treatment From Boston Neurobehavioral Associates
Whether you are exploring TMS for the first time or considering Spravato after antidepressants have not worked, we will evaluate your full history and co-create a plan that fits your life. Book an appointment at BNBA today and discuss your mental health concerns with the experts.
Frequently Asked Questions About TMS and Spravato
Is TMS safer than Spravato?
Both treatments are considered safe when administered in a certified clinical setting, but their safety profiles are quite different.
Does TMS work faster than Spravato?
No. Spravato works faster than TMS. Some patients notice mood improvement within hours of their first dose.TMS typically takes two to four weeks of consistent sessions to show any significant benefits.
Can untreated depression become more serious over time?
Yes, and this is an important reason to take treatment seriously. Untreated depression can cause real physical harm, including cardiovascular risk, immune dysfunction, and chronic pain.