Key Takeaways
- TMS (transcranial magnetic stimulation) is FDA-cleared, and Spravato® (esketamine nasal spray) is FDA-approved for treatment-resistant depression, but they work in very different ways.
- TMS uses magnetic pulses and is usually given five days a week for several weeks, while Spravato is a nasal spray given in a certified clinic, starting twice a week and then less often.
- Neither treatment is better for everyone, and the right fit depends on your health history, your schedule, and how past treatments have worked for you.
- The two options aren't mutually exclusive, so a provider can help you decide whether one, the other, or both in sequence make sense.
- Foundation Psychiatry offers both TMS and Spravato in Atlanta, and you can request an appointment with Foundation Psychiatry to talk through which one fits you.
What Is Treatment-Resistant Depression?
Depression that doesn't improve enough after trying two oral antidepressants is called treatment-resistant depression, or TRD. It's more common than many people think. According to Johnson & Johnson's announcement of the 2025 FDA approval for Spravato, about one-third of adults with major depressive disorder (MDD) will not respond to oral antidepressants alone.
If that sounds like your story, you're not out of options. Two of the newer treatments for TRD are TMS and Spravato. You can learn more about symptoms and care options on the Foundation Psychiatry depression treatment page.
How TMS Works
TMS is a noninvasive treatment, which means it doesn't involve surgery or needles. During a session, a provider places a magnetic coil against your scalp. The coil sends gentle magnetic pulses to the part of the brain involved in mood.
According to the Mayo Clinic overview of transcranial magnetic stimulation, TMS:
- Doesn't require anesthesia, so you stay awake and alert.
- Is usually used when other depression treatments haven't worked.
- Lets most people go back to normal activities right after each session.
See how TMS is offered in Atlanta on the Foundation Psychiatry TMS therapy page.
How Spravato Works
Spravato is a nasal spray that contains esketamine, a medicine related to ketamine. You use the spray yourself while a healthcare provider watches. Spravato is only given at clinics certified in the Spravato REMS (Risk Evaluation and Mitigation Strategy) program, a safety program required by the FDA.
Spravato works on glutamate, a chemical messenger in the brain. Since January 2025, it has been FDA-approved for adults with TRD either on its own or along with an oral antidepressant, according to Johnson & Johnson.
Learn what Spravato treatment looks like on the Foundation Psychiatry Spravato treatment page.
TMS vs. Spravato: Side-by-Side Comparison
| TMS | Spravato | |
|---|---|---|
| What it is | Magnetic pulses from a coil placed on the scalp | Esketamine nasal spray you use under supervision |
| How it affects the brain | Stimulates nerve cells in a mood-related brain area | Acts on glutamate, a brain chemical messenger |
| Medication involved? | No | Yes, Spravato is a prescription medicine |
| Typical early schedule | Five days a week for 4 to 6 weeks | Twice a week for the first 4 weeks |
| Time in the office | About 3 to 20 minutes, depending on the protocol | At least 2 hours of monitoring after each dose |
| Driving afterward | You can usually drive between treatments | You need someone to drive you home, and you shouldn't drive until the next day |
| Common side effects | Scalp discomfort, headache, facial twitching, lightheadedness | Feeling disconnected, dizziness, nausea, sleepiness, raised blood pressure |
Sources: Mayo Clinic for TMS details and the Spravato Medication Guide for Spravato details.
What a Course of Treatment Looks Like
The day-to-day experience is one of the biggest differences between these two treatments.
A Typical TMS Course
- First visit: Your provider 'maps' the best spot to place the coil and finds the right strength. This first visit usually takes about an hour.
- Regular sessions: Sessions usually happen five days a week for 4 to 6 weeks.
- After each session: Most people go right back to work or their day. Some people get a short headache.
A Typical Spravato Course
- Weeks 1 to 4: Sessions twice a week.
- Weeks 5 to 8: Sessions once a week.
- Week 9 and beyond: Sessions every two weeks or once a week, based on how you respond.
This schedule comes from the J&J Medical Connect overview of Spravato dosing. Each visit includes at least two hours of monitoring, so plan for a ride home.
Which Option Might Fit You?
These questions aren't a self-test. They're a way to get ready for your first conversation with a provider.
TMS may be worth asking about if you:
- Would rather try a treatment that doesn't involve medication.
- Can fit short, frequent visits into your weekday schedule.
- Want to drive yourself to and from appointments.
Spravato may be worth asking about if you:
- Prefer fewer visits per week after the first month.
- Can set aside a few hours per visit and arrange a ride home.
- Are open to a medication-based approach.
Your health history also matters. For example, TMS may not be safe for some people with certain metal implants or devices. Spravato isn't recommended during pregnancy, and it isn't appropriate for people with certain blood vessel conditions or a history of bleeding in the brain. A provider will review these details with you.
Can You Use Both TMS and Spravato?
Yes, these treatments aren't 'either-or.' Depending on your history, a provider may talk with you about trying one first, or using both at different points in your care plan.
Treatment-Resistant Depression Options in Atlanta
Foundation Psychiatry is located in the Buckhead/Midtown area of Atlanta. The practice combines psychotherapy (talk therapy) and psychopharmacology (medication management) with advanced options like TMS and Spravato.
You can explore every option on the Foundation Psychiatry treatments page.
Compare TMS and Spravato With an Atlanta Psychiatry Team
TMS and Spravato are both evidence-based options for depression that hasn't responded to standard treatment, and the best choice depends on you. Foundation Psychiatry can walk you through how each one fits your history, schedule, and goals.
Ready to find out which option makes sense? Request an appointment with Foundation Psychiatry to discuss TMS therapy and Spravato treatment in Atlanta.
Frequently Asked Questions
What is the difference between TMS and esketamine?
TMS uses magnetic pulses to stimulate a mood-related area of the brain, and it doesn't involve medication. Esketamine (Spravato) is a prescription nasal spray that acts on a brain chemical called glutamate. TMS is usually given five days a week for several weeks. Spravato starts at twice a week and then becomes less frequent.
Is TMS or Spravato better for treatment-resistant depression?
Neither one is better for everyone. TMS is FDA-cleared and Spravato is FDA-approved for treatment-resistant depression. The right choice depends on your medical history, your schedule, your preferences, and how you've responded to past treatment.
Can I drive myself home after TMS or Spravato?
After TMS, most people can drive and return to normal activities. After Spravato, you need someone else to drive you home. You shouldn't drive until the next day after a restful sleep.
Does insurance cover TMS or Spravato?
Coverage varies by plan. According to Mayo Clinic, most insurance policies cover TMS for depression if certain conditions are met, such as having tried a minimum number of antidepressants. Check with your insurance company, and review the Foundation Psychiatry insurance and pricing page for more details.
Where can I find treatment-resistant depression options in Atlanta?
Foundation Psychiatry offers both TMS and Spravato at its office on Collier Road NW in Atlanta. A consultation can help you understand which option may fit your needs.
