Overcoming Treatment-Resistant Depression: Is Spravato or TMS Right for You?

Depression can affect almost every part of your life, from your mood to your sleep to your work and relationships. While many people see improvements in symptoms with antidepressant medication and therapy, some continue to experience a low mood despite treatment. This is called treatment-resistent depression (TRD).

If standard treatments haven’t provided relief from your depression, our team at NYC Psychiatric Associates in Midtown Manhattan can talk to you about other options. Two treatments we provide for TRD include Spravato® and transcranial magnetic stimulation (TMS) therapy. 

But which is right for you? 

What is Spravato?

Spravato is a prescription nasal spray containing esketamine. It’s FDA-approved to treat adults with TRD, as well as adults with major depressive disorder having suicidal thoughts and behaviors.

Unlike traditional antidepressants, which primarily act on specific neurotransmitters involved in mood (serotonin and norepinephrine), esketamine acts on the brain’s glutamate system. Glutamate is an excitatory neurotransmitter that assists with nerve cell communication and plays a key role in learning and memory. 

Esketamine blocks N-methyl-D-aspartate (NMDA) receptors, the main receptors for glutamate, influencing the signaling of the neurotransmitter in a way that may help change neural connections between brain cells involved in mood. 

Spravato is given at the office under close supervision due to side effects such as sedation, dizziness, and dissociation. 

Protocols vary, but you might need more frequent treatments at the beginning, then less frequent sessions as you reach maintenance. 

What is TMS?

TMS is a noninvasive treatment that uses magnetic pulses to stimulate specific areas of the brain known to play a role in mood regulation. 

During a TMS session, we place a magnetic coil against your scalp and deliver repeated magnetic pulses. The pulses create small electrical currents in targeted areas of the brain, stimulating nerve cells and influencing activity in the areas of the brain that manage moods. 

With regular treatments, TMS may improve communication between the areas involved in mood regulation, alleviating symptoms.

TMS is FDA-cleared to treat major depressive disorders that haven't improved with traditional treatments. We conduct TMS therapy at the office, with 20- to 40-minute sessions done 5 days a week for several weeks. We don’t use anesthesia for treatment, and you can resume your usual day afterward. 

You may experience common side effects, including scalp discomfort or mild headaches, after treatment.

Spravato vs. TMS: Which is for you?

No one treatment is best for all. We take many factors into consideration when deciding the methods that can best help you, including symptoms, treatment history, other medical conditions, and how quickly you need to improvement.

We may recommend Spravato if you have TRD and are in need of a medication-based approach. TMS is appealing to those looking for a nonmedication option. Though, with both treatments, we do recommend you continue your antidepressant medication and therapy.

We can help you weigh the potential benefits, risks, logistics, and expected treatment schedule. 

TRD is frustrating, but not getting improvements after trying multiple treatments doesn’t mean you can’t feel better. Advances in psychiatric care provide additional options for those who haven’t found relief with conventional approaches.

If you have ongoing depression symptoms and have tried everything available, it’s time to look at other options, including Spravato and TMS. We can talk with you about these treatments and help you decide if one makes a good approach for you.

Call, text or message our office, located in the Murray Hill Section of New York City, New York,  today.