Two different tools for the same problem
TMS (transcranial magnetic stimulation) and Spravato (esketamine nasal spray) both exist for people whose depression has not improved enough on antidepressant medication. That is where the similarity ends. TMS is a device-based treatment: an FDA-cleared system delivers targeted magnetic pulses to stimulate brain regions that are underactive in depression, with no medication involved. Spravato is a medication: an FDA-approved nasal spray, taken together with an oral antidepressant, that works through a different brain mechanism (the glutamate system) than standard antidepressants.
Neither is "stronger" than the other in any universal sense — they suit different situations, histories, and lives. That is why the comparison worth making is practical, not promotional.
What the schedules look like
TMS is a short daily appointment, typically five days a week for several weeks. Sessions are brief, require no anesthesia or sedation, and you drive yourself home and go about your day. The commitment is frequency — it works best when the daily rhythm is practical for your commute and schedule.
Spravato is typically twice weekly at first, tapering in frequency over time. Each visit is longer: the dose is administered in a certified clinic, followed by an in-office monitoring period, and you cannot drive until the next day — so every session needs a ride home. The commitment is per-visit depth rather than daily frequency.
Eligibility and history differ too
TMS is FDA-cleared for adults with major depressive disorder who have not benefited adequately from antidepressant medication. Screening covers things like metal implants in the head and seizure history. Spravato is FDA-approved specifically for treatment-resistant depression and is taken alongside an oral antidepressant; screening considers blood pressure, certain medical conditions, and medication interactions.
Insurance coverage differs by plan for both, and both usually require prior authorization documenting your treatment history. This is paperwork our team handles routinely — coverage often ends up driving part of the decision, so a benefits check early is worth it.
How the decision usually gets made
In practice, the choice comes down to a conversation with a psychiatric provider who knows your full history: what you have tried, your medical background, your schedule and transportation reality, and your preferences about medication versus device-based treatment. Some patients try one and later the other; the two can be sequenced.
One structural advantage worth knowing: at a practice that offers both — as Allen Psychiatry does, on one campus — the recommendation is not shaped by which single service a clinic happens to sell. If the first choice does not deliver enough relief, changing course is a follow-up appointment, not a new clinic search.
Where to go from here
This article is for general education from a patient's perspective — it is not medical advice, a diagnosis, or a substitute for an evaluation with a qualified provider.