Our team recommends TMS or Spravato based on your diagnosis, safety screening, past treatment history, medical conditions, and daily life. TMS is often the first choice for patients who want a drug-free option or who cannot safely take Spravato. Spravato is often favored when faster relief is a priority and the patient can manage supervised in-office dosing. Because we offer both treatments at Myndful Wellness, we have no reason to steer you toward one over the other. The goal is to match the treatment to you.
We wrote this article to show the reasoning behind that recommendation. Below, we compare how each treatment works, what sessions feel like, how results tend to unfold, and which factors carry the most weight during an evaluation.
Both TMS and Spravato are options for adults whose depression has not improved enough with standard antidepressants. They reach the same goal through different routes.
TMS is a noninvasive procedure that uses magnetic pulses to stimulate brain areas involved in mood. Spravato is an esketamine nasal spray taken in our office under supervision.
In general, our clinicians lean toward:
TMS first when a patient prefers to avoid more medication, has a history of substance use, has certain blood pressure or vascular concerns, or cannot arrange a ride home after each session.
Spravato first when symptoms are severe and faster relief matters, when a patient has metal implants or devices that rule out TMS, or when a patient has a seizure history that makes TMS less suitable.
Both together when depression has resisted several treatments. Some patients do well using TMS and Spravato as part of one plan.
The rest of this article explains why.
The biggest difference is simple. TMS is a procedure. Spravato is a medication.
With TMS, nothing enters your body. A device placed near your head delivers focused magnetic pulses, and you leave the session as you arrived. Our office uses Exomind with an accelerated protocol, which is drug-free, noninvasive, and requires no downtime.
Spravato is a prescription drug. It contains esketamine, which is delivered as a nasal spray. Because it acts on the brain chemically, it can cause temporary effects that require monitoring. For that reason, it is only given in a certified treatment setting, and patients take it alongside an oral antidepressant.
This difference shapes almost every other part of the decision. It affects side effects, who can safely receive each treatment, how you get home afterward, and how the treatment fits with your other medications.
TMS stands for transcranial magnetic stimulation. Depression is linked to lower activity in certain mood-regulating regions of the brain. TMS sends magnetic pulses through the scalp to gently activate those regions. Over a series of sessions, this repeated stimulation helps the brain strengthen and rebuild healthier communication patterns.
Spravato works on a brain chemical called glutamate. Most traditional antidepressants target serotonin or norepinephrine. Glutamate plays a central role in how brain cells form new connections. By acting on this system, Spravato offers a different pathway for patients who have not found relief with standard medications.
Although the methods differ, both treatments support neuroplasticity, which is the brain’s ability to form new connections and adapt. That shared goal is one reason they can work well side by side.
The experience of each treatment is quite different, and this often matters as much as the science.
A TMS session. You sit comfortably while the device delivers pulses. Most people describe a tapping sensation on the scalp. You stay awake and alert the entire time. When the session ends, you can drive yourself home, return to work, or go about your day. There is no recovery period.
A Spravato session. You give yourself the nasal spray under the observation of our staff. You then stay in our office for a monitoring period while any short-term effects pass. Many patients feel relaxed, drowsy, or a little detached during this window. You cannot drive for the rest of the day, so someone needs to take you home. Our office offers private rooms for Spravato sessions, which gives patients a quiet, personal space during monitoring.
Our office uses greens and plants throughout, and patients often tell us the space feels warm and relaxing. For patients who want extra support, we also offer Vibroacoustic Therapy in our sound lounge as an add-on to their care.
Both treatments are used for treatment-resistant depression, meaning depression that has not improved enough after trying antidepressant medications. Many patients who have felt stuck for years see meaningful improvement with one or both of these options.
Neither treatment is guaranteed to work for everyone. Response depends on the individual, the type and severity of depression, other health conditions, and how consistently the treatment plan is followed. Our clinicians do not view one as stronger than the other across the board. The better question is which one is more likely to work for a specific patient.
For patients with depression that has resisted several approaches, combining TMS and Spravato is one of the more powerful strategies available. We are able to offer that combination within one office, which keeps care coordinated.
Speed is one of the clearest differences between the two.
Spravato can work quickly. Some patients notice a lift in mood within hours to days of their first doses. This speed is one reason our clinicians may consider it first for patients with severe symptoms.
TMS improvements usually build gradually as sessions add up. Traditional TMS schedules can stretch over many weeks. Our accelerated Exomind protocol is designed to deliver treatment in a more compact timeframe, which can be helpful for patients who travel to see us or have limited time.
Durability is the other half of the picture. After a full TMS course, many patients maintain their improvement for months. Some return for additional sessions if symptoms begin to creep back. Spravato is typically continued on an ongoing schedule after the first phase of treatment, with sessions spaced further apart over time.
Neither treatment is a one-time fix, and planning for what comes after matters.
With TMS, ongoing care often means periodic check-ins and possible booster sessions. Because TMS does not add medication, it does not change your prescription list.
With Spravato, ongoing care means continued in-office sessions, regular monitoring, and an oral antidepressant taken alongside it. Patients need a dependable ride home after every session for as long as treatment continues.
Our clinicians also provide Medication Management, so we can adjust prescriptions as your response to TMS or Spravato becomes clear. We prescribe medications when they help, and we also recognize that not every patient needs more medication. Some do better with a treatment that supplements or replaces part of their current regimen.
TMS side effects are usually mild and short-lived. The most common are scalp discomfort at the treatment site and headache. These often ease as treatment continues. Because TMS does not enter the bloodstream, it does not cause weight gain, sexual side effects, or sedation.
Spravato side effects usually appear during the monitoring period and fade the same day. They can include:
Feeling detached or disconnected from your surroundings
Dizziness or a spinning sensation
Nausea
Sleepiness
A temporary rise in blood pressure
These effects are the reason Spravato is only given under supervision. Our staff checks on patients throughout the monitoring period and confirms they are ready before they leave with their driver.
Some medical factors make one treatment unsafe or less suitable. These patients are often better suited to TMS. For patients navigating depression during or after pregnancy, our Perinatal Mental Health care helps guide that conversation.
TMS tends to suit patients who:
Prefer a drug-free option
Have had side effects from several antidepressants
Need to drive themselves or return to work right after treatment
Have a history of substance use
Have blood pressure or vascular concerns
Are pregnant or planning a pregnancy
Spravato tends to suit patients who:
Need relief as quickly as possible
Have metal implants or devices that rule out TMS
Have a seizure history
Are already taking an oral antidepressant and can continue it
Can reliably arrange a ride home after each session
Many patients fit both lists. When that happens, personal preferences and practical factors usually decide the starting point.
The decision starts with a full Psychiatric Evaluation. Our clinicians, including Jessica Schmalz, Psychiatrist, look at your full history before making a recommendation.
This is the core of TMS vs Spravato: How Our Team Decides Which One to Try First. We do not start from a preferred treatment and work backward. We start with your history and let the facts point toward the right fit. Because we offer both treatments, we can recommend whichever one makes the most sense and adjust later if needed.
The evaluation is a conversation. We explain what we see, why one option may fit better, and what the alternatives look like. You leave with a clear understanding of your options and a recommended next step. TMS and Spravato are mainly used for major depression that has not responded well enough to standard treatment. Learn more about how we approach depression treatment as a whole.
We also look at symptom severity and safety. When a patient is struggling significantly and needs relief quickly, Spravato’s faster onset may weigh heavily. Patients with other conditions, such as anxiety or PTSD, receive a plan that accounts for the full picture.
Your treatment history tells us a great deal. We ask which medications you have tried, at what doses, for how long, and what happened.
If you have struggled with medication side effects again and again, TMS may be a better next step because it adds no new drug. If you tolerate antidepressants well but have not gotten enough benefit, Spravato may be a reasonable addition to your current medication. Past experience with Therapy and other treatments also helps us understand what has and has not moved the needle.
We review your full medical history. This includes blood pressure, heart and vascular conditions, neurological history, implants, and any history of head injury.
Current medications matter as well. Others can interact with Spravato or affect blood pressure. Because our clinicians manage medications directly, we can make adjustments that make either treatment safer and more effective.
Your preferences carry real weight. Some patients feel strongly about avoiding more medication. Others are comfortable with medication and care most about speed.
Lifestyle is just as important. We ask about work schedules, childcare, and whether you can take time away after a session. A patient who needs to drive to work right after treatment may lean toward TMS. A patient with flexible days and a reliable support person may find Spravato easy to fit in.
Before any treatment begins, we complete a structured safety screening. For Spravato, it centers on blood pressure, vascular history, substance use history, and pregnancy status.
A screening result can settle the question quickly. If a patient has a cochlear implant, TMS is off the table and Spravato becomes the natural option. If a patient has a history of bleeding in the brain, Spravato is ruled out and TMS moves forward.
You are an active part of this decision. These questions can help you get the most out of your evaluation:
Based on my history, which treatment do you think fits me better, and why?
Is there anything in my medical history that rules out either option?
How soon might I notice a change with each treatment?
How will my current medications fit with each option?
What does ongoing care look like after the first phase of treatment?
Would combining TMS and Spravato make sense for me?
Could add-on support, such as Vibroacoustic Therapy, help my overall plan?
Bring a list of medications you have tried, along with any side effects you remember. The more detail you share, the more accurate our recommendation can be.
After your evaluation, our clinicians share a recommendation and explain the reasoning behind it. If you agree with the plan, we move forward with any required paperwork and benefit checks.
Once treatment begins, we track how you respond. If progress is slower than expected, we may adjust the plan, add the other treatment, or change medications. Starting with one option does not lock you in. Having both treatments in one office makes it simple to shift course without starting over somewhere new.
Learn more on our TMS Treatment and Spravato pages.
TMS and Spravato both help adults with treatment-resistant depression, but they work differently and suit different people. TMS is drug-free with no downtime. Spravato can work faster but requires supervised dosing and a ride home. Our clinicians weigh your diagnosis, treatment history, medical safety, preferences, and logistics to recommend a starting point, and we can adjust or combine treatments as your care progresses.
About the Author
Jessica Schmalz
Ready to Feel Like Yourself Again?
October 14, 2026
