For nearly 3 million Americans struggling with treatment-resistant depression, finding effective treatments can feel like an endless search. However, newer treatments like transcranial magnetic stimulation (TMS) and ketamine might be a beacon of hope.
As we dive into TMS therapy vs. ketamine treatment, we’ll compare both treatment options by looking at how they work, their effectiveness, side effects, costs, and insurance coverage, so you can determine which treatment might best fit your needs.
Ketamine was initially FDA-approved as an anesthetic but has recently gained attention for its effects on depression. Many patients with treatment-resistant depression or suicidal thoughts have found relief with ketamine when other antidepressants haven’t worked.
There are two ways ketamine can be administered:
In a healthy brain, there’s a balance between excitatory signals that activate brain cells and inhibitory signals that quiet brain cells down. Depression disrupts this balance; however, when ketamine is administered, it blocks the receptors (NMDA receptors) and channels (HCN channels) in the brain that normally help regulate these patterns.
As ketamine blocks these receptors, it weakens the inhibitory signals in the brain. This allows previously silent brain cells to become active, thus creating new communication patterns and changing how different parts of the brain talk to each other. The brain’s ability to form these new connections, called neuroplasticity, may be why some patients continue feeling better even after ketamine has left their system.
When receiving ketamine, patients may experience altered perceptions and sensations that usually go away once a treatment session ends. Some people might even feel detached from reality or experience a dreamlike state during treatment. Other short-term side effects of ketamine treatment may include:
Most of these side effects are temporary and resolve within hours after treatment. However, more serious side effects can occur with long-term or heavy use, including:
Ketamine treatment should always be supervised by a healthcare provider. They’ll carefully screen you for risk factors, and once deemed safe, they’ll monitor you for side effects throughout your treatment to ensure the best outcome.
Studies on ketamine treatment for depression have found varying rates of improvement, but many show significant benefits for a large portion of patients:
Individual results vary, and ketamine may not work for everyone. Factors like depression severity, previous treatments, and personal health history can all influence treatment outcomes.
Ketamine treatment for depression typically requires paying out-of-pocket since most insurance companies don’t cover it due to it being “experimental.” That being said, costs can differ depending on where you’re located and who you see for treatment. A single infusion can range from $400 to $800, although some providers may charge more. Since most treatments require multiple sessions, the total cost can be a burden on many patients.
TMS is an FDA-approved, non-invasive treatment for depression. This therapy uses magnetic pulses to stimulate specific brain areas that are in charge of mood regulation.
During treatment, a magnetic coil placed against the scalp creates a field that passes through the skull to activate brain cells. Patients feel a tapping sensation and hear clicking sounds as the magnet pulses (earplugs are provided for hearing protection). Unlike electroconvulsive therapy (ECT), TMS doesn’t induce seizures or cause memory loss.
TMS corrects abnormal brain activity patterns associated by stimulating the prefrontal cortex, which is typically underactive in people with depression.
Recent research from Stanford shows that in healthy brains, signals normally flow from the anterior insula (which processes bodily sensations) to the anterior cingulate cortex (which regulates emotions). In depressed brains, this flow is reversed–signals travel backward from the emotion center to the sensation center. The more severe the depression, the more signals flow in this reversed direction.
TMS therapy normalizes this signal flow and restores proper communication between brain regions. As the correct neural pathways are reestablished through repeated stimulation, depression symptoms improve. Patients with the most severe signal disruption often experience the greatest benefit from treatment.
TMS has a favorable safety profile with most side effects being mild and temporary. Less than 5% of patients discontinue treatment due to adverse effects. Common side effects include:
These side effects are usually a result of the magnetic pulses causing contractions of scalp muscles near the treatment coil and go away as treatment continues or with over-the-counter pain relievers.
There is a small risk of hearing damage from the clicking sounds produced by the magnetic coil, but this is easily prevented by wearing earplugs during treatment sessions.
The most serious potential side effect is seizure, but this is extremely rare. Most patients can return to normal activities immediately after each session, including driving and working, as TMS doesn’t affect alertness or cognitive function.
Recent studies have backed up the efficacy of TMS therapy for depression:
These results suggest that TMS can be highly effective for treating depression, especially with newer advancements like brain imaging that target treatment more precisely to each individual’s brain.
TMS therapy costs around $300 per treatment session, with a complete course usually requiring 20-30 sessions. Without insurance, this can add up to $6,000-$9000 total.
The good news is that insurance coverage has improved. All major insurance companies now cover TMS, though they have specific requirements depending on the policy:
If you’re considering TMS, it’s worth checking with both your insurance provider and treatment center to understand your coverage options.
While both TMS therapy and ketamine treatment offer hope for those struggling with depression, they work in different ways and results can vary from person to person.
When considering TMS therapy, it may be more appropriate if:
On the other hand, ketamine may be a better fit if:
Your personal medical history and treatment goals should be taken into consideration when making a decision between ketamine and TMS. Discuss your options with a healthcare provider as they will be able to recommend the most appropriate option for your treatment plan.
Depression can be a frustrating experience, especially if you haven’t had success with traditional treatments. We understand that depression affects everyone differently, which is why we offer a range of comprehensive care including therapy, medication management, and advanced treatments like TMS.
Our team of mental health professionals will work with you to find a treatment plan that works best for you based on your specific needs, symptoms, and treatment history. Contact us today to learn more about how we can help you get relief from your depression.
Cracking the Ketamine Code – National Institute of Mental Health
Penn Medicine Study Gives Peek of How Ketamine Acts as ‘Switch’ in the Brain – Penn Medicine
Ketamine – National Institute on Drug Abuse
Ketamine found effective in treating severe depression – The Harvard Gazette
How Magnetic Brain Stimulation Helps Relieve Depression – Science Friday
Researchers treat depression by reversing brain signals traveling the wrong way – Stanford Medicine
Brain stimulation poised to move from last resort to frontline treatment – PNAS
Experimental depression treatment is nearly 80% effective in controlled study – Stanford Medicine
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
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Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
