When depression has not improved enough with medication, a TMS vs Spravato decision deserves more than a side-by-side list. A psychiatrist reviews the diagnosis, earlier treatment, medical risks, current medicines, daily schedule, transportation, and insurance rules. The result should be an individualized recommendation, not a promise that one option is best for everyone.
Quick guide
The short answer on TMS vs Spravato
TMS and SPRAVATO can both be considered after depression has not responded adequately to earlier treatment, but they work differently and require different routines. TMS uses magnetic pulses delivered through a coil placed against the scalp. SPRAVATO is the brand name for esketamine nasal spray, administered under direct observation in a certified healthcare setting.
The 2022 U.S. Department of Veterans Affairs and Department of Defense guideline suggests repetitive TMS after partial or no response to two or more adequate medication trials. It also suggests esketamine as an option after several adequate medication trials. The guideline does not rank the two options against each other.[1]
A comparison article cannot establish candidacy. The clinician needs to verify the diagnosis, review the adequacy of earlier treatment, screen for medical and psychiatric safety concerns, and understand what schedule the patient can reliably complete.
How a psychiatrist evaluates TMS vs Spravato
The diagnosis and current level of risk
The evaluation starts with the current depressive episode. The clinician may ask about sleep, energy, concentration, anxiety, agitation, substance use, and changes in daily functioning. They should also ask about past periods of unusually high energy, reduced need for sleep, impulsivity, psychotic symptoms, or other features that could change the diagnosis or treatment plan.
Current safety matters immediately. Tell the clinician about suicidal thoughts, a plan, recent self-harm, or a rapid decline in your ability to function. An outpatient comparison may no longer be the first priority when urgent evaluation or a higher level of care is needed.
What happened with earlier treatment
A medication name alone does not show whether a trial was adequate. The psychiatrist will usually need the dose, duration, benefit, side effects, reason it stopped, and whether the medicine was taken consistently. Psychotherapy, psychiatric hospitalization, and other relevant care also belong in the history.
The FDA-cleared indication for the NeuroStar system includes adults with major depressive disorder who did not achieve satisfactory improvement from antidepressant medication in the current episode.[2] Current FDA labeling lists SPRAVATO for treatment-resistant depression in adults, either alone or with an oral antidepressant, and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior when used with an oral antidepressant.[3] An FDA indication does not guarantee that a treatment is clinically appropriate or covered by a particular plan.
Medical history, medicines, and patient preference
Bring a full medication and supplement list. The clinician needs to review neurological history, blood pressure, cardiovascular and cerebrovascular history, pregnancy, implanted devices or metal, substance use, and medicines that may affect risk. Preferences count too. Some people are more concerned about a frequent series of shorter appointments; others cannot arrange a ride home after a monitored visit.
How the treatment days differ
TMS appointments
NeuroStar TMS is delivered while the patient is awake. It does not require anesthesia. FDA documentation for one NeuroStar protocol describes five sessions per week for six weeks, followed by six taper sessions over three weeks, for 36 sessions total.[2]
- A coil is positioned against the scalp.
- The visit does not include a required two-hour medication observation period.
- Transportation is usually easier because the treatment itself does not involve sedation.
- The exact protocol and session length depend on the prescribed treatment.
SPRAVATO appointments
SPRAVATO is self-administered under direct observation in a certified healthcare setting. The FDA requires monitoring for at least two hours after each dose, including respiratory monitoring and blood-pressure assessment.[3]
- The induction schedule is commonly twice weekly for four weeks.
- Later frequency may step down according to the label and clinical response.
- A responsible adult must drive the patient home.
- Driving and other alertness-dependent activities wait until the next day after a restful sleep.[4]
Those differences can outweigh a small preference based on reading alone. A person working a fixed weekday shift may struggle with a five-day TMS schedule. Another person may be unable to arrange transportation after every SPRAVATO visit. Discuss barriers before authorization begins so the treatment plan is realistic.
Safety screening can change the recommendation
TMS safety screening pays close attention to metal or electronic implants in or near the head, seizure history, neurological conditions, hearing protection, current medicines, and factors that may affect seizure risk. Common treatment-related concerns include scalp discomfort and headache. The clinician should explain the device-specific risks and what would lead the team to adjust or stop a session.[5]
SPRAVATO has a boxed warning for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors in pediatric and young adult patients taking antidepressants. The FDA label also calls for blood-pressure checks and lists vascular conditions for which an increase in blood pressure or intracranial pressure creates serious risk.[3]
Tell the psychiatrist about every implant, neurological event, blood-pressure problem, and substance-use concern. Online eligibility checklists cannot account for the location of an implant, the details of a prior medical event, or interactions among current medicines.
Records and insurance affect the starting point
The clinical recommendation comes first, but records can determine whether an insurer has enough information to review it. Bring pharmacy printouts or a written list of prior antidepressants, approximate dates, doses if known, side effects, and the reason each medicine stopped. Records from a former prescriber can fill gaps without requiring you to remember every date.
Plans may apply different prior-authorization criteria to TMS and SPRAVATO. They may ask for documentation of diagnosis, earlier medication trials, psychotherapy, symptom scores, safety screening, or the proposed schedule. Approval for one option does not establish approval for the other, and authorization does not guarantee payment of every charge.
Review the practice’s insurance and payment information, then call the member-services number on your card. Ask whether Kalamazoo TMS & Behavioral Health is in network for the exact service and what deductible, copay, coinsurance, site-of-care, or specialty-pharmacy rules apply.
Planning treatment at the Portage office
Kalamazoo TMS & Behavioral Health provides TMS and monitored SPRAVATO care at 5930 Lovers Lane, third floor, Portage, Michigan 49002. Patients travel from Kalamazoo, Portage, Oshtemo, Texas Township, Mattawan, Battle Creek, and other Southwest Michigan communities.
Before choosing, put the full course on a calendar. Include travel, check-in, appointment time, weather, work, childcare, and recovery time. For SPRAVATO, include a driver for the trip home. The Portage location page can help you review the office location before planning repeated visits.
Learn more about TMS therapy in Kalamazoo, monitored SPRAVATO treatment, and the practice’s approach to treatment-resistant depression. These pages describe the services; the evaluation connects them to your history.
Questions to bring to the evaluation
- What diagnosis and treatment history make each option reasonable or unsuitable for me?
- Which safety concern matters most in my case?
- What exact appointment schedule would you prescribe?
- What transportation, work, or caregiving arrangements should I make?
- What records will my insurer need before it reviews authorization?
- How will we measure symptoms and daily functioning during treatment?
- What would lead you to adjust, pause, or change the plan?
A useful recommendation should explain the reasoning in plain language. Ask for written next steps, especially if depression makes it hard to retain a long discussion.
Frequently asked questions
Which works faster, TMS or SPRAVATO?
Individual response cannot be predicted from a general comparison. The treatments have different study designs, schedules, indications, and monitoring requirements. A psychiatrist should discuss the evidence that applies to your diagnosis without promising a particular speed or outcome.
Can I drive after treatment?
TMS does not require anesthesia, so the treatment itself usually does not create a driving restriction. Follow individualized instructions if symptoms or another medicine affect alertness. After SPRAVATO, arrange transportation home and do not drive until the next day after a restful sleep.[4]
Can I switch if the first option does not help enough?
A psychiatrist may reconsider the plan when benefit is limited, side effects are difficult, safety changes, or the schedule becomes unworkable. The next step depends on how much treatment was completed, the response, the diagnosis, medical risks, and coverage.
Does insurance prefer one option?
There is no single rule across plans. TMS and SPRAVATO can have separate medical-necessity criteria, authorization forms, networks, and cost-sharing. Ask the clinic and insurer to check the exact plan before treatment is scheduled.
Do I need a perfect medication history?
No. Bring what you can: a pharmacy printout, current medication list, names of past prescribers, approximate dates, and any records you already have. The treatment team can tell you which missing details matter for the clinical and insurance review.
Request an evaluation for TMS vs Spravato
A sound TMS vs Spravato recommendation connects the medical evidence with your diagnosis, safety, treatment history, schedule, transportation, and coverage. That decision belongs in a psychiatric evaluation rather than an online scorecard.
Request a new-patient evaluation with Kalamazoo TMS & Behavioral Health. Use the current form to share your care needs and insurance information with the team.
This article is educational and does not replace individualized medical advice, diagnosis, emergency care, or an insurer’s plan documents.
References
- U.S. Department of Veterans Affairs and Department of Defense: Clinical Practice Guideline for the Management of Major Depressive Disorder, February 2022.
- U.S. Food and Drug Administration: NeuroStar Advanced Therapy System 510(k) Summary, K220127.
- U.S. Food and Drug Administration: SPRAVATO full prescribing information, revised April 2025.
- U.S. Food and Drug Administration: SPRAVATO Medication Guide, revised September 2026.
- U.S. Food and Drug Administration: Repetitive Transcranial Magnetic Stimulation Systems, Class II Special Controls Guidance.
