TMS vs. Spravato for Treatment-Resistant Depression

If you are struggling with depression that has not improved after trying multiple antidepressants, TMS and Spravato® offer two advanced, FDA-approved options. TMS uses gentle magnetic pulses to stimulate the brain, while Spravato is a prescription nasal spray given under medical supervision. The right choice depends on your health history, schedule, comfort level, and how your body responds.

At Gianan Health in Bolingbrook, IL, both treatments are available to help match you with the option that fits your life. Below, we break down how each works, what to expect, and how to think through the decision.

What Is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) is a form of major depressive disorder that does not improve enough after trying two or more antidepressant medications at proper doses and for a proper length of time. It does not mean you have failed – it simply means your brain may need a different approach than standard oral medication.

Reaching this diagnosis starts with a careful evaluation of your treatment history: the medications you have tried, the dosages, how long you took them, and how you responded to them. At Gianan Health, our team of nurse practitioners and therapists takes the time to listen and understand your full story, so patients feel heard and not rushed.

Impact on Patients

Living with depression that will not lift can be exhausting. Persistent sadness, fatigue, hopelessness, and loss of interest can affect work, relationships, sleep, and basic self-care. Many people describe feeling like they are running out of options.

That feeling of being stuck is exactly why TMS and Spravato exist – both were developed for people whose depression has not responded to standard care. Learn more about our approach to depression and related conditions.

Overview of TMS and Spravato

Gianan Health is one of the practices in the Bolingbrook area offering both treatments, providing two distinct pathways toward recovery.

What Is TMS?

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses focused magnetic fields to stimulate nerve cells in areas of the brain linked to mood regulation, which are often underactive in people with depression.

• No medication, sedation, or needles

• You stay fully awake and alert during each session

• You can drive yourself home afterward

• Avoids many of the body-wide side effects of oral antidepressants

Read more on our TMS therapy page.

What Is Spravato (Esketamine)?

Spravato is the brand name for esketamine, a prescription nasal spray. It is chemically related to ketamine but specifically formulated and FDA-approved to treat adults with TRD. Because it is a medication, it is always given under medical supervision at the clinic – patients cannot take it at home. Each session lasts about two hours, including monitoring. See our Spravato treatment page for more detail.

How Each Treatment Works

How TMS Works

Depression is often linked to reduced activity in the prefrontal cortex, the part of the brain responsible for mood regulation and executive function. TMS delivers short magnetic pulses through a coil placed against the scalp. These pulses pass painlessly through the skull, generating a small electrical current that stimulates nerve cells – effectively “waking up” and strengthening brain circuits that have become underactive.

The effect builds gradually. Rather than one dramatic change, most people notice improvement slowly across several weeks of consistent treatment.

How Spravato Works

Most traditional antidepressants work by increasing serotonin, norepinephrine, or dopamine. Spravato instead acts on the glutamate system – the brain’s most common excitatory neurotransmitter – which is involved in learning, memory, and mood. By targeting the NMDA receptor, it helps rapidly restore synaptic connections damaged by long-term stress and depression.

Because it acts on the brain quickly, some people notice a shift in mood within hours or days – one reason Spravato is used for TRD.

Treatment Experience

At Gianan Health, we prioritize patient comfort and scheduling flexibility for both treatments.

TMS Treatment Process and Schedule

A typical TMS course involves daily sessions, five days a week, for about six to nine weeks.

• Session length: Roughly 20 to 40 minutes, depending on the protocol

• Process: You sit comfortably in a chair while the coil is positioned over the target area of your head, staying fully awake and alert

• Afterward: No sedation and no recovery time – you can drive yourself home or back to work immediately

What TMS Feels Like

During a session, you will hear a series of clicking sounds and feel a tapping sensation on your scalp under the coil. Some people feel mild scalp discomfort in the first few sessions, which usually fades. You can read, listen to music, talk, or simply relax – and when the session ends, you go about your day.

Spravato Treatment Process and Schedule

Spravato treatment is administered under the direct supervision of our clinical team in our Bolingbrook office.

• Schedule: The initial phase typically involves two sessions per week for the first month, then decreases based on your response

• Process: You self-administer the nasal spray in our office, then remain for a monitoring period of at least two hours

• Afterward: You cannot drive, operate heavy machinery, or make important decisions on treatment day, so you must arrange transportation home

Unlike some of our services, which patients use through telehealth, Spravato patients must be physically present at the clinic. This is a safety requirement, not a preference.

What Spravato Treatment Looks Like

During the two-hour monitoring period, you rest in a comfortable, private setting. Many patients bring headphones, an eye mask, or a blanket. Some feel a floating or dreamlike sensation, mild dizziness, or a sense of detachment, which usually eases before they leave. Our team monitors your blood pressure and checks on you periodically, then clears you to go home with your ride.

Effectiveness Comparison

Effectiveness of TMS

Studies show about 50–60% of people with TRD experience a clinically meaningful response to TMS, and about one-third achieve full remission. The effects can be long-lasting, with many patients remaining symptom-free for a year or more after completing treatment – all without adding another pill to your routine.

Effectiveness of Spravato

Spravato’s main strength is its speed of action, with some patients feeling better within 24 hours of their first dose. Because it targets a different brain system, it offers a genuinely new option when serotonin-based drugs have not helped.

TMS vs. Spravato: Which Is More Effective?

There is no single winner – effectiveness is highly individual. TMS may appeal to someone who wants a medication-free approach and can commit to regular short visits. Spravato may appeal to someone who wants faster relief and can arrange transportation and longer clinic visits. The most effective treatment is the one that fits your biology and your lifestyle, which is why a personalized evaluation matters more than any general comparison.

Side Effects and Safety

Both treatments are safe when administered by trained professionals, but their side effect profiles differ.

Side Effects of TMS

TMS is localized and avoids systemic effects like weight gain or sexual dysfunction. Common side effects are mild and temporary:

• Headache

• Scalp discomfort at the treatment site

• Tingling or twitching of facial muscles during the session

Side Effects of Spravato

Spravato is systemic, so its effects occur during and shortly after treatment and typically resolve before you leave the clinic:

• Dissociation (feeling disconnected from yourself or reality)

• Dizziness or “spinning” sensation (vertigo)

• Nausea

• Sedation or sleepiness

• Temporary increase in blood pressure

With Spravato, the key considerations are the temporary effects during and after the session, which is why supervision and a ride home are required. Our providers review your medical history in detail before recommending either option.

Eligibility and Suitability

A thorough evaluation with one of our providers determines your eligibility.

Who Is a Good Candidate for TMS?

TMS may be a strong fit if you:

• Have tried and failed multiple antidepressant medications

• Prefer a non-medication, non-invasive approach

• Cannot tolerate the side effects of medications

• Want to stay fully alert and drive yourself to and from appointments

• Can commit to daily weekday sessions over several weeks

• Do not have metal implants in or near your head (e.g., aneurysm clips, stents, cochlear implants)

Who Is a Good Candidate for Spravato?

Spravato is approved for adults with TRD or MDD with acute suicidal thoughts or behaviors. It may be a strong fit if you:

• Need rapid relief from severe depressive symptoms

• Have not responded to other antidepressants

• Are open to a nasal-spray medication used alongside an oral antidepressant

• Can arrange transportation after each treatment

• Can commit to the full two-hour in-clinic monitored session

Explore all of our services to see how these options fit into a fuller care plan.

Key Differences at a Glance

How to Choose the Right Treatment

This decision is not one you have to make alone. Start with practical factors: Can you commit to short weekday sessions, or do you prefer fewer but longer visits? Can you arrange a ride, or do you need to drive yourself? Do you want to avoid adding medication, or are you comfortable with a supervised nasal spray? Then consider your medical history, since certain factors can point toward one option.

At Gianan Health, we don’t use a “cookie-cutter” approach – patients are given the time to feel heard. Our providers lead care with a focus on comfort and scheduling flexibility so treatment fits into your real life. Our team is here to guide you every step of the way.

Conclusion

TMS and Spravato are two effective options for those who have not improved with standard antidepressants. TMS uses magnetic stimulation and requires no medication, while Spravato is a fast-acting nasal spray given during a monitored clinic visit. The right fit depends on your health, schedule, and comfort.

At Gianan Health in Bolingbrook, both treatments are available and personalized to your needs. If ongoing depression has left you searching for answers, a thorough evaluation is the first step toward relief.

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