Written by Corina Girigan, DNP, PMHNP-BC, FNP-C — Psychiatric Nurse Practitioner specializing in depression, anxiety, addiction, and medication management at New Dawn Psychiatric Care. Read full bio →
Updated: [07/07/2026]
Spravato vs TMS: Which Depression Treatment Is Right for You?
When comparing Spravato vs TMS, there is no single “best” treatment for everyone with depression. Both treatments are FDA-approved options commonly used for treatment-resistant depression, but they work in very different ways. Spravato is a medication administered as a nasal spray under medical supervision, while Transcranial Magnetic Stimulation (TMS) uses magnetic pulses to stimulate specific areas of the brain without medication.
The right choice depends on your symptoms, treatment history, medical considerations, lifestyle, and personal preferences. A psychiatric evaluation can help determine which approach may offer the greatest benefit for your situation.
TL;DR
- Spravato and TMS are both evidence-based treatments for treatment-resistant depression.
- Spravato uses a prescription medication called esketamine, while TMS uses magnetic stimulation and does not involve medication.
- Spravato appointments require monitoring after treatment, while patients can typically drive themselves home after TMS sessions.
- The best option depends on your treatment history, medical needs, and personal preferences.
Table of Contents
- What Is the Difference Between Spravato and TMS?
- How Do Spravato and TMS Compare Side by Side?
- Which Treatment Works Faster?
- What Does the Treatment Experience Feel Like?
- Which Option Fits Better Into Your Schedule?
- Who Tends to Be a Better Candidate for Spravato?
- Who Tends to Be a Better Candidate for TMS?
- How Do Providers Decide Between Spravato and TMS?
- How Can New Dawn Psychiatric Care Help?
- Frequently Asked Questions
What Is the Difference Between Spravato and TMS?
The biggest difference between Spravato and TMS is how they affect the brain.
Spravato contains esketamine, a medication that works through glutamate pathways involved in communication between brain cells. The treatment is administered as a nasal spray in a certified medical office and is used alongside an oral antidepressant.
TMS uses targeted magnetic pulses to stimulate areas of the brain associated with mood regulation. No medication is administered during treatment, and patients remain awake throughout the procedure.
Both treatments are designed for individuals whose depression has not responded adequately to traditional antidepressant medications.
How Do Spravato and TMS Compare Side by Side?
Patients often find it helpful to compare the practical differences before exploring which option may be a better fit.
|
Feature |
Spravato |
TMS |
|
Treatment Type |
Prescription medication |
Non-medication brain stimulation |
|
FDA Approved |
Yes |
Yes |
|
Used For |
Treatment-resistant depression and certain cases of major depression with suicidal thoughts |
Treatment-resistant depression and other approved indications |
|
Administration |
Nasal spray |
Magnetic stimulation device |
|
Monitoring Required |
Yes |
No post-treatment monitoring required |
|
Driving After Treatment |
No |
Usually yes |
|
Oral Antidepressant Required |
Yes |
Not necessarily |
|
Treatment Setting |
Certified medical office |
Outpatient treatment center |
Both treatments have strong clinical evidence supporting their use, but the patient experience differs significantly.
Which Treatment Works Faster?
Many patients ask about speed because they have often been struggling with depression for months or years.
Some patients receiving Spravato report symptom improvement relatively early in treatment, sometimes within days or weeks. Clinical response varies, and improvement timelines differ from person to person.
TMS typically requires a series of treatments over several weeks before full benefits can be evaluated. Some patients notice gradual improvement during treatment, while others experience changes later in the process.
The important consideration is not only how quickly improvement occurs, but whether the improvement is meaningful and sustainable over time.
What Does the Treatment Experience Feel Like?
The day-to-day experience of treatment is often one of the biggest deciding factors.
During a Spravato Appointment
Spravato appointments generally last several hours.
Patients administer the medication under supervision and remain in the office afterward for monitoring. Some people experience temporary dizziness, drowsiness, nausea, or dissociation during treatment.
Transportation home must be arranged because patients cannot drive after treatment.
During a TMS Appointment
TMS appointments are considerably shorter.
Patients sit in a treatment chair while magnetic pulses are delivered to targeted brain regions. Most sessions last less than an hour, and patients typically return to work, school, or normal activities immediately afterward.
Some individuals report mild scalp discomfort or headaches, particularly during the early stages of treatment.
Which Option Fits Better Into Your Schedule?
Treatment effectiveness matters, but logistics matter too.
Spravato requires dedicated appointment time because of the observation period after treatment. Patients should plan for transportation and reduced activity afterward.
TMS usually involves more frequent appointments, often several times per week, but each session is shorter and generally does not require recovery time.
For some patients, longer but less frequent appointments feel more manageable. Others prefer shorter visits that fit around work and family responsibilities.
Lifestyle Considerations
You may want to discuss:
- Work schedule flexibility
- Transportation availability
- Childcare responsibilities
- Distance from the treatment center
- Previous treatment experiences
These factors do not determine effectiveness, but they can influence whether a treatment plan is realistic and sustainable.
Who Tends to Be a Better Candidate for Spravato?
Many Spravato candidates share a similar history.
They have often:
- Tried multiple antidepressants without sufficient relief
- Experienced persistent symptoms despite treatment
- Sought alternatives after conventional approaches were unsuccessful
- Been evaluated and cleared for treatment within the Spravato REMS program
A psychiatric provider must review medical history, medications, and overall health before recommending treatment.
Who Tends to Be a Better Candidate for TMS?
TMS may appeal to patients who prefer a non-medication treatment option.
Some patients pursue TMS because:
- They want to avoid adding another medication
- Medication side effects have been difficult to tolerate
- They prefer a treatment that does not require post-session monitoring
- Their provider believes TMS may align well with their treatment history
The best candidate is not determined by preference alone. Clinical factors remain the most important consideration.
How Do Providers Decide Between Spravato and TMS?
Providers do not choose treatments based solely on diagnosis.
A comprehensive evaluation considers:
|
Clinical Factor |
Why It Matters |
|
Previous medication response |
Helps identify likely treatment pathways |
|
Severity of symptoms |
Guides treatment planning |
|
Medical history |
Determines safety considerations |
|
Current medications |
May influence treatment recommendations |
|
Lifestyle and scheduling needs |
Helps improve treatment adherence |
|
Patient preferences |
Supports shared decision-making |
The goal is to match the treatment to the person rather than force every patient into the same approach.
How Can New Dawn Psychiatric Care Help?
At New Dawn Psychiatric Care, we understand that choosing between Spravato and TMS can feel overwhelming, especially after years of struggling with depression.
Our team provides comprehensive psychiatric evaluations and individualized treatment recommendations based on your symptoms, treatment history, medical background, and goals. Rather than focusing on a one-size-fits-all solution, we help patients understand the benefits, limitations, and practical considerations of each treatment option.
If you are exploring advanced treatments for depression, we can help you determine which path makes the most sense for your unique situation.
Frequently Asked Questions
Is Spravato more effective than TMS?
Research supports both treatments for treatment-resistant depression. Effectiveness varies between individuals, and one treatment is not universally superior to the other.
Can I receive both Spravato and TMS?
Some patients receive both treatments at different points in their care. Whether combining or sequencing treatments is appropriate depends on your clinical situation and provider recommendations.
Which treatment has fewer side effects?
The side effect profiles are different rather than better or worse. Spravato can cause temporary dizziness, sedation, nausea, and dissociation. TMS is more commonly associated with scalp discomfort or headaches.
Does insurance cover Spravato and TMS?
Many insurance plans cover both treatments when medical necessity criteria are met. Coverage requirements vary by insurer and policy.
Which treatment requires more appointments?
TMS often involves more frequent appointments over several weeks. Spravato appointments are typically longer because of the required observation period after treatment.
About New Dawn Psychiatric Care
New Dawn Psychiatric Care provides comprehensive psychiatric evaluation, medication management, and advanced depression treatment options for adults seeking personalized mental health care. Our team works with individuals experiencing depression, anxiety, mood disorders, and treatment-resistant depression, including those who have not found sufficient relief through traditional antidepressant medications. Through evidence-based care and individualized treatment planning, we help patients explore options such as Spravato treatment as part of a broader path toward recovery.
About the Author
Written by Corina Girigan, DNP, PMHNP-BC, FNP-C- is a board-certified Psychiatric Mental Health Nurse Practitioner at New Dawn Psychiatric Care. She specializes in the evaluation and treatment of depression, anxiety disorders, mood disorders, and treatment-resistant mental health conditions. Through a combination of psychiatric assessment, medication management, and advanced treatment options, Corina Girigan helps patients develop treatment plans tailored to their unique symptoms, goals, and life circumstances.
Connect with Corina Girigan: