What is TMS?
TMS is a non-invasive brain stimulation therapy that uses gentle magnetic stimulation on specific areas of the brain involved in mood regulation.
Understanding Alternatives for Treatment-Resistant Depression
Understanding Alternatives for Treatment-Resistant Depression
Medications are not your only option! Here’s a breakdown of three promising treatment options: Transcranial Magnetic Stimulation (TMS), Spravato (esketamine), and IV ketamine.
Transcranial Magnetic Stimulation (TMS)
What it is:
TMS is a non-invasive brain stimulation therapy that uses gentle magnetic stimulation on specific areas of the brain involved in mood regulation.
How it works:
A device placed on the left side of your scalp sends painless magnetic pulses to stimulate neurons in an area of the brain called the prefrontal cortex. This helps "reset" brain activity in people with depression by improving communication in mood-regulating circuits.
What to expect:
- Outpatient sessions 5 times/week for a total of 35 sessions
- The first appointment is the ‘mapping’—where’ we use our technology to determine something called your motor threshold. This allows us to find your treatment threshold, which is 120% of the motor threshold, and the level of stimulation we give you at each treatment
- Sessions last about 20–40 minutes each
- No sedation - you can drive yourself to and from appointments!
Side effects:
- Mild headache or scalp discomfort
- Very low risk of serious side effects - no memory loss as compared to electroconvulsive therapy (ECT)
Not recommended in patients with:
- Intracranial metal implants such as cochlear implants, aneurysm clips, or stents
- Presence of other implantable medical devices, such as pacemakers
- History of adverse events related to previous TMS therapy
Caution in those with pregnancy, severe or recent heart disease, intracranial stimulation electrodes, cardiac stents or pacemakers, hearing impairment, epilepsy, or elevated intracranial pressure.
Spravato (Esketamine Nasal Spray)
What it is:
Spravato is a nasal spray version of esketamine, a form of ketamine approved by the FDA for treatment-resistant depression and depressive symptoms in adults with suicidal thoughts.
How it works:
Esketamine targets glutamate, a brain chemical involved in mood regulation. It works faster than most traditional antidepressants, with patients often seeing improvement within the first few treatments
What to expect:
- Urine drug screening required prior to treatment
- Administered in our clinic under provider supervision
- Patients will be monitored for 2 hours by staff, with intermittent blood pressure checks
- Sessions begin as 2 times/week for the first month, then once weekly for the second month, then once every 2 weeks or once monthly for maintenance if recommended based on treatment response
- Due to sedative effects, designated driver is required to and from each appointment
Side effects:
- Dizziness, nausea, sedation, dissociation (feeling detached from reality)
- Short-term increase in blood pressure
Not recommended in patients with:
- Active substance use or abuse
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation.
- History of intracerebral hemorrhage.
- History of hypersensitivity to esketamine, ketamine, or related
IV Ketamine Infusion Therapy
What it is:
IV ketamine is an off-label treatment using low doses of ketamine (a general anesthetic) to rapidly reduce symptoms. Current evidence has shown improvements in patients with treatment-resistant depression, bipolar depression, anxiety disorders, and post-traumatic stress disorder.
How it works:
It modulates glutamate activity in the brain, leading to rapid antidepressant effects - often within hours!
What to expect:
- Urine drug screening required prior to treatment
- 1.5-2 hour long appointment, where ketamine is infused via IV catheter in office
- Typically 2 treatments/week over a period of 3 weeks for 6 total treatments
- 60 mL infused over a period of 40 minutes, with an additional 30 minute recovery period following treatment
- Vitals are monitored every 5 minutes during the treatment period. Patient is connected to a blood pressure monitor, oxygen monitor and EKG
- Blood pressure checked every 15 minutes in recovery period
- Due to sedative effects, designated driver is required to and from each appointment
- Option of ongoing maintenance as recommended by provider
Side effects:
- Dizziness, nausea, sedation, dissociation (feeling detached from reality)
- Short-term increase in blood pressure
Not recommended in patients with:
- psychosis, even if it is a symptom of a major depressive episode
- neurocognitive disorders, including dementias
- traumatic brain injury that is symptomatic
- alcohol use disorder or other substance use disorder
- use of illicit substances - must be clean of all illicit substances throughout treatment period
Which is Right for You?
Each of these treatments offers hope for people who haven’t found relief with traditional approaches. Your best option depends on your:
- Diagnosis and symptoms
- Medical history
- Preferences and lifestyle
- Insurance coverage and/or financial status
We’re here to help.
Contact our clinic to schedule a consultation and explore the next steps toward healing.
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What is SPRAVATO®?
What it is:
SPRAVATO® is a nasal spray version of esketamine, a form of ketamine approved by the FDA for treatment-resistant depression and depressive symptoms in adults with suicidal thoughts.
What it is IV Ketamine?
IV Ketamine is an off-label treatment using low doses of ketamine (a general anesthetic) to rapidly reduce symptoms. Current evidence has shown improvements in patients with treatment-resistant depression, bipolar depression, and anxiety disorders.
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