How to Choose the Right Treatment for Depression That Won’t Go Away
If you’ve tried multiple antidepressants with little or no relief, you’re not alone. Many people living with treatment-resistant depression (TRD) reach a point where they ask: What else is out there? At that crossroads, three advanced options often come up: Spravato®, IV ketamine, and transcranial magnetic stimulation (TMS).
While all three can be effective, they work in different ways and may be a better fit for some people than others.
In this post, we’ll compare these treatments side by side to help you better understand your options and start a conversation with your provider about what might be right for you.
You can also visit our Spravato® treatment page for an overview of the treatment process.
Spravato® is the only FDA-approved esketamine-based treatment for adults with treatment-resistant depression. It’s a nasal spray taken in a certified clinical setting under supervision and must be used alongside a traditional oral antidepressant.
Unlike SSRIs or SNRIs that target serotonin or norepinephrine, Spravato® works on the brain’s glutamate system. Some patients report feeling relief within days or weeks.
What Is Ketamine Treatment?
IV ketamine therapy uses a form of the same base compound (ketamine) but is not FDA-approved for depression. It’s often used “off-label” in wellness or specialty clinics and delivered by intravenous infusion. These sessions can be effective for some patients but are generally not covered by insurance and may have looser safety protocols than REMS-certified Spravato® centers.
What Is TMS (Transcranial Magnetic Stimulation)?
TMS is a non-invasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. Sessions are conducted in-office five days a week over several weeks and can be covered by insurance for those who meet criteria. TMS does not involve medication, needles, or sedation, making it a good option for some patients with sensitivity to medications.
To learn more, visit our TMS therapy page.
Comparison Table: Spravato® vs Ketamine vs TMS
|
Feature |
Spravato® |
IV Ketamine |
TMS |
|
FDA Approved for Depression |
✅ Yes |
❌ No |
✅ Yes |
|
Delivery Method |
Nasal spray |
IV infusion |
Magnetic pulses (external) |
|
Monitoring Required |
✅ Yes (2 hrs) |
✅ Yes (vitals monitored during infusion) |
✅ Staff-supervised |
|
Covered by Insurance |
✅ Often |
❌ Rarely |
✅ Often |
|
Use with Antidepressants |
Required |
Optional |
Optional |
Who Might Benefit From Spravato®?
Spravato® may be a good option if you:
- Have tried at least two antidepressants without improvement
- Are not comfortable with IV infusions
- Prefer FDA-approved, insurance-covered care
- Want supervised treatment in a structured setting
- Are open to combining medication and talk therapy
Who Might Prefer Ketamine or TMS?
IV Ketamine may appeal to those seeking off-label options or for those who don’t qualify for Spravato® due to medical or insurance limitations.
TMS may be a great fit for individuals who:
- Prefer non-medication treatments
- Have mild to moderate depression
- Want a treatment with minimal systemic side effects
- Can commit to daily sessions for four to six weeks
Can These Treatments Be Combined?
Yes, some treatments for depression can be used together, depending on your individual needs and your provider’s recommendations.
For example:
- Spravato® is always used in combination with an oral antidepressant.
- Many patients continue seeing a therapist or counselor during Spravato®, TMS, or ketamine treatment. Talk therapy can enhance outcomes by helping you process change and strengthen coping strategies.
- Some patients may explore TMS after Spravato® or vice versa if symptoms change or return later.
At Compassionate Psychiatric Services, we take an integrated approach. This means we may recommend combining advanced treatments with medication management or counseling and therapy services to create a care plan that reflects your goals.
Still Not Sure Which Is Right for You?
At Compassionate Psychiatric Services, our providers in Frisco and Southlake, TX work with you to understand your symptoms, history, and preferences then help guide you toward the most effective option.
If Spravato® is a fit, we will:
- Complete a full psychiatric evaluation
- Help verify insurance and manage approvals
- Provide supervised in-office treatment
- Offer adjustments and support throughout your plan
If another treatment or combination is more appropriate, we’ll help you explore that too.
Learn More Before Starting
Want to learn more about what to expect? Read our post Starting Spravato®? Here’s What to Know About Insurance, Side Effects, and Safety.
You can also check out How Spravato® Works Differently Than Traditional Antidepressants or Why Spravato® Must Be Administered Under Clinical Supervision.
