Esketamine vs. TMS: Which Is Right for You?

When depression doesn’t respond to standard treatments like antidepressant medication and psychotherapy, it can feel frustrating and discouraging. Fortunately, advancements in mental health care have made effective alternatives available for individuals with treatment-resistant depression. Two of the most well-established options are esketamine and Transcranial Magnetic Stimulation (TMS), each offering a different approach to relieving symptoms and restoring quality of life.

What Is Esketamine?

Esketamine is a prescription nasal spray derived from ketamine and approved for adults with treatment-resistant depression and major depressive disorder with acute suicidal thoughts. Unlike traditional antidepressants that target serotonin or dopamine, esketamine works on the brain’s glutamate system, helping to restore neural connections that are often disrupted by depression.

Key Features of Esketamine:

• Administered as a nasal spray in a medical office

• Typically taken twice weekly at first, then reduced over time

• Patients are monitored for about two hours after each session

• Often produces rapid symptom relief, sometimes within days

Esketamine may be especially helpful for individuals who need faster improvement in symptoms or who have not responded to multiple antidepressant medications.

What Is TMS Therapy?

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment that uses targeted magnetic pulses to stimulate areas of the brain involved in mood regulation. TMS does not require medication, sedation, or anesthesia and is performed while you are awake and alert.

Key Features of TMS:

• Non-invasive and drug-free

• Sessions last about 20-40 minutes

• Typically completed 5 days a week for 4-6 weeks

• No systemic side effects and no recovery time

TMS is often a strong choice for individuals who prefer a non-medication approach or who have experienced unwanted side effects from antidepressants.

Esketamine vs. TMS

Esketamine and TMS differ primarily in how they treat depression. Esketamine is a medication administered as a nasal spray that works on the brain’s glutamate system, while TMS is a non-medication therapy that uses magnetic pulses to stimulate mood-related areas of the brain.

The treatment experience also varies. Esketamine requires fewer weekly visits but includes in-office monitoring after each session. TMS sessions are shorter and require no recovery time, though they are typically scheduled five days a week for several weeks.

Relief may occur at different speeds. Esketamine can provide rapid symptom improvement for some patients, while TMS works more gradually over the course of treatment. Choosing between esketamine and TMS depends on factors like prior treatment response, symptom severity, lifestyle, and personal preference, and should be guided by a mental health professional.

Which Option Is Right for You?

Choosing between esketamine and TMS depends on several factors, including:

• Your history with antidepressant medications

• The severity and urgency of your symptoms

• Personal preference regarding medication vs. non-medication treatments

• Medical history and provider recommendations

In some cases, patients may benefit from one treatment over the other, and in others, both may be considered at different stages of care. A comprehensive psychiatric evaluation is the best way to determine the most appropriate option.

Find the Right Treatment for Your Needs

Both esketamine and TMS offer hope for individuals struggling with depression that hasn’t responded to traditional treatments. While esketamine provides rapid relief through medication-based brain chemistry changes, TMS offers a non-medication approach that gently retrains brain activity over time. The right choice is highly personal and should be guided by your symptoms, lifestyle, and clinical needs.

If you or a loved one is struggling with treatment-resistant depression, schedule a consultation with Renaissance Behavioral Medicine to learn more about esketamine therapy and TMS. Visit our office in Beverly Hills, California, or call (213) 816-3900 to schedule a consultation today.