# TMS vs Spravato: How Two Depression Treatments Compare

> TMS vs Spravato for depression that hasn't improved with antidepressants: how each works, visit time, driving, side effects and insurance in Richmond, VA.

URL: https://foundationmedicalgroup.org/tms-vs-spravato/
Published: 2026-10-28
Updated: 2026-10-28

TMS and Spravato are both options for depression that hasn’t improved with antidepressants, and the TMS vs Spravato choice is mostly about how each one fits your life. TMS sends magnetic pulses through the scalp while you’re awake, and you can drive home. Spravato is an esketamine nasal spray with at least 2 hours of monitoring, and no driving until the next day. We offer both in Richmond, Virginia.
What Is the Difference Between TMS Therapy and Spravato Treatment? TMS therapy (repetitive transcranial magnetic stimulation) is a device treatment. A coil held against your scalp sends repeated, low-intensity magnetic pulses to the brain. No anesthesia, no hospital, just an office chair. According to the National Institute of Mental Health, the FDA cleared the first rTMS device in 2008, for people whose depression didn’t respond to at least one antidepressant in the current episode.
Spravato treatment is something else entirely: a medication. It’s an esketamine nasal spray approved for adults with treatment-resistant depression, used alone or with an oral antidepressant, and given only in a certified setting.
So one is magnetic stimulation and one is a medicine, but both answer the same problem. They’re the two treatment options we offer for hard-to-treat depression: TMS therapy in Richmond and Spravato treatment in Richmond. No Foundation Medical Group clinic in Utah, Georgia or Texas offers either one today. (Our Utah page marks both as planned, not available yet.)
How Does TMS Treatment Work? For depression, the coil sits over the left prefrontal cortex, a part of the brain involved in mood regulation. The magnetic field is about as strong as an MRI’s. You stay awake the whole time. And yes, it’s noisy: you’ll hear a knocking or tapping sound during each pulse train.
At our clinic we use NeuroStar TMS. A session takes about 19 minutes, 3 to 5 days a week, and most patients finish in about 6 weeks. The National Institute of Mental Health describes a typical course as daily, 5 days a week, for 4 to 6 weeks.
You may also read about deep TMS, which can use two coils, and accelerated TMS, which packs a course into a shorter time, often within a week. A 2025 expert review found that TMS continues to show broad evidence for safety and efficacy in depression, and that newer forms are faster. Faster sounds good, obviously. Whether it’s better for you is a separate question. Still, NeuroStar TMS is the system we use here. Our guide to TMS for depression covers a full course step by step.
Is Spravato the Same as Esketamine Nasal Spray? Yes. Same drug, two names. Spravato is the brand name of esketamine nasal spray. Esketamine is one form (the S-enantiomer) of ketamine, and it blocks the brain’s NMDA receptor, a glutamate receptor. That’s a different path from traditional antidepressants.
Spravato esketamine isn’t the same as IV ketamine. IV ketamine is a different drug form given through a vein, while Spravato is a nasal spray you use yourself in a medical facility, under a clinician’s watch. You, your doctor and your pharmacy must be enrolled in a safety program called the Spravato REMS before you can receive it.
For how the spray works step by step, read how Spravato works.
TMS vs Spravato Side by Side TMS (NeuroStar at our clinic) Spravato What it is Magnetic stimulation device Prescription esketamine nasal spray Time per visit About 19 minutes At least 2 hours, with monitoring How often 3 to 5 days a week, about 6 weeks Twice a week in weeks 1 to 4, once a week in weeks 5 to 8, then weekly or every 2 weeks Driving after You can drive yourself home No driving until the next day after restful sleep Other medicines Usually continue Used alone or with an oral antidepressant Where we offer it Richmond, VA only Richmond, VA only Look at that table again. The biggest gap isn’t really the science, it’s the calendar. Your psychiatrist matches the option to your treatment history, your health and your week, and every patient’s mix is different.
Which Gives Faster Relief, TMS Therapy or Spravato? Spravato tends to act sooner. According to the prescribing information, in a key study of Spravato for treatment-resistant depression, most of the difference between Spravato and placebo was seen at 24 hours. But the label still says to judge the benefit at the end of the 4-week induction phase.
TMS therapy builds up over weeks. Expert consensus says symptoms may ease as early as 2 to 3 weeks, and a standard course is 20 to 30 sessions over 6 weeks. Many of our patients notice a first lift in two to three weeks.
For context, traditional antidepressants usually take a few weeks to work, which is why faster treatments are an active research area. Faster isn’t the same as rapid relief in a crisis, though. We know that’s hard to hear when you’ve waited months for something to help. Neither treatment is for an emergency. If you’re thinking about suicide, call or text 988 now.
Can You Drive After TMS Therapy or Spravato? After TMS therapy, yes. There’s no anesthesia or sedation, so you can drive yourself home and go back to work or your day.
After Spravato treatment, no. The Medication Guide says someone must drive you home after each treatment, and you shouldn’t drive or run machinery until the next day after a restful sleep. In the first month that means a ride twice a week. Annoying? A bit. So line up your rides before you start the nasal spray.
What Are the Side Effects of Each Treatment? TMS side effects are usually mild: discomfort where the coil sits, tingling of the scalp, jaw or face, mild headaches, or brief lightheadedness. A seizure is possible but rare. Our page on TMS therapy side effects goes deeper.
Spravato’s most common side effects are dissociation (feeling disconnected from yourself), nausea, dizziness, headache, anxiety, vomiting, feeling drunk, raised blood pressure and sleepiness. The Medication Guide notes that blood pressure can stay up for about 4 hours. The label carries a boxed warning for sedation, dissociation, slowed breathing, abuse and misuse, and suicidal thoughts in young people, which is why every dose is watched. See Spravato side effects for what to expect at each visit.
Either way, tell us about any change in your mental health between visits, even one that seems small.
Who Is TMS Treatment Not Recommended For? TMS treatment isn’t given to people with magnetic-sensitive metal implanted in the head or neck near the coil, such as metal plates, clips or electrodes. Expert guidance also asks about a personal or family history of epilepsy or seizures before treatment. NIMH notes rTMS isn’t approved for youth under 15.
Spravato therapy isn’t used in people with a blood vessel disease such as an aneurysm, an arteriovenous malformation, a history of bleeding in the brain, or an allergy to esketamine or ketamine. Tell your doctor about high blood pressure, heart disease or liver disease too.
That’s why your full medical history and medicine list matter. A psychiatric evaluation is where we sort out which option is safe for you. People also ask about TMS for trauma or how it compares with neurofeedback; at our clinic, we use TMS for depression.
Can You Have TMS Therapy and Spravato Treatment at the Same Time? Honestly? There’s no direct guidance we can point you to on combining the two. What we know: the 2018 expert consensus found no known absolute reason to stop psychiatric medicines during TMS therapy, and it asks that every medicine change be recorded. Spravato treatment is itself used alone or with an oral antidepressant.
Whether to combine them, or which to try first, is a call for your psychiatrist after looking at your previous treatment. Medication management carries on either way.
After a course, some patients move to a tapering TMS schedule. A 2023 review found that maintenance TMS appears to lower the risk of relapse, though its exact role isn’t settled. Spravato continues weekly or every 2 weeks after week 8 when it’s working. Read more in how long TMS lasts.
Which Treatment Fits Your Treatment History? TMS may suit you if you want a treatment with no sedation, need to drive or work the same day, and can come in most weekdays for about 6 weeks.
Spravato may suit you if you can plan 2-hour visits with a driver, you’re staying on an oral antidepressant, and your plan covers it.
Not sure which one sounds like you? That’s normal. It’s what the first visit is for.
Either way, bring your treatment history: which antidepressants you tried, at what length, what side effects you had, and any talk therapy. It shapes your depression treatment plan and your insurance paperwork. Our guides to treatment-resistant depression and Spravato for depression can help you prepare, and TMS in Richmond explains a first visit.
Does Insurance Cover TMS and Spravato Treatment? Insurance coverage depends on your plan, so call to confirm coverage before you start. At our Richmond clinic we work with Medicaid, Anthem, Aetna, Cigna, Blue Cross Blue Shield, UnitedHealthcare, Humana, TRICARE and Optum Behavioral Health for TMS. Our Spravato page names Anthem, Aetna, Cigna, UnitedHealthcare, Optima and Virginia Medicaid. Call to confirm coverage for your exact plan. We don’t accept Medicare in Virginia at this time.
Our coordinators file the prior authorization for you. Bring a list of the medicines you’ve tried; it helps with that paperwork. Read does insurance cover TMS, or call (800) 983-1974.
Key Takeaways TMS and Spravato both treat depression that hasn’t responded to antidepressants; one is a device, one is a medication. TMS at our clinic: about 19 minutes, 3 to 5 days a week for about 6 weeks, and you drive yourself home. Spravato: at least 2 hours of monitoring per visit, and no driving until the next day. In a key study, most of Spravato’s difference from placebo showed up at 24 hours; TMS builds over weeks. We offer both in Richmond, Virginia only. Call to confirm coverage; we don’t accept Medicare in Virginia. Sources National Institute of Mental Health, Brain Stimulation Therapies. DailyMed (National Library of Medicine), SPRAVATO (esketamine) nasal spray, prescribing information. DailyMed, SPRAVATO Medication Guide. MedlinePlus, Esketamine Nasal Spray. McClintock SM et al., Consensus Recommendations for the Clinical Application of rTMS in the Treatment of Depression, Journal of Clinical Psychiatry, 2018. Consensus review and considerations on TMS to treat depression: a comprehensive update, Clinical Neurophysiology, 2025. National Institute of Mental Health, Rapidly-Acting Treatments for Treatment-Resistant Depression (RAPID). Investigating the Role of Maintenance TMS Protocols for Major Depression, Journal of Personalized Medicine, 2023.