TMS vs. Ketamine: Which Depression Treatment is Right for You?

What is TMS?

Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses magnetic fields to stimulate areas of the brain involved in mood regulation. It is performed on an outpatient basis, requiring no anesthesia or hospitalization.

How TMS Works

During TMS therapy, an electromagnetic coil is placed on the scalp, targeting the prefrontal cortex—a region that is often underactive in people with depression. The magnetic pulses stimulate neuron activity, helping restore normal brain function.

TMS also enhances neuroplasticity, or the brain’s ability to form new neural connections. This process can help “re-wire” dysfunctional nerve pathways associated with depression, improving mood and the ability to adopt healthier thought patterns.

Conditions Treated with TMS

TMS is approved by the US Food and Drug Administration (FDA) for depression, obsessive-compulsive disorder (OCD), and smoking addiction. However, its primary use is for treatment-resistant depression (TRD), as it shows significant benefits for those who have previously found no or little relief from using standard antidepressant medications. 

What is Ketamine Therapy?

Originally developed as an anesthetic, ketamine has gained recognition as a promising treatment for mental health conditions such as:

• Depression
• Anxiety disorders
• Post-Traumatic Stress Disorder (PTSD)

Like TMS, ketamine is particularly beneficial for individuals who have not responded to traditional treatments.

The generic form of ketamine is used off-label for mental health conditions, while Spravato (esketamine)—a nasal spray derived from ketamine—is FDA-approved for Treatment-Resistant Depression (TRD) and major depressive disorder with suicidal ideation (MDSI).

How Ketamine Works

Ketamine increases activity in the prefrontal cortex (PFC) and other brain regions associated with depression. It boosts neuroplasticity but does so by interacting with NMDA receptors, rather than using magnetic stimulation like TMS.

Unlike TMS, ketamine’s effects are less localized, which can increase the likelihood of side effects.

Comparing Effectiveness: TMS vs. Ketamine

How Quickly Do They Work?

• TMS requires 30–36 sessions over 4–6 weeks. Most patients experience a gradual reduction in depressive symptoms, with sustained improvement after completing the full course.
• Ketamine provides rapid relief, often within hours to days. An initial course typically includes two sessions per week for about a month.

Response Rates

• TMS: Studies show that 50–60% of individuals with TRD experience significant improvement, and about one-third achieve full remission.
• Ketamine: Around 50% of TRD patients respond to ketamine, with 30% achieving full remission. However, ketamine’s effects are shorter-lived than TMS, requiring ongoing maintenance infusions.

At True North Clinic in Anchorage, Alaska, we are committed to long-term results. We combine high-quality, personalized care with state-of-the-art TMS technology to ensure the best possible outcomes for our patients.

Side Effects and Safety

TMS Side Effects

TMS is considered safe and is well-tolerated by most patients. The most common side effects include:

• Mild scalp discomfort or tingling during treatment
• Occasional headaches, which usually resolve on their own
• Temporary hearing changes (ear protection is provided)

In rare cases, TMS may trigger seizures or induce mania in individuals with bipolar disorder. However, these effects are extremely uncommon.

At True North TMS in Anchorage, we prioritize patient safety. Our expert staff will evaluate your medical history to ensure TMS is a safe and effective option for you.

Ketamine Side Effects

Ketamine therapy is known for its more pronounced side effects, including:

• Dissociation (feeling detached from reality)
• Dizziness or nausea during and after treatment
• Temporary increases in blood pressure and heart rate

Because of its psychoactive effects, ketamine has a potential for misuse. Chronic recreational use can lead to bladder damage, memory issues, and cognitive impairment.

While ketamine is safe in a clinical setting, its effects may not be suitable for everyone.

Cost Comparison: TMS vs. Ketamine

TMS Costs and Insurance Coverage

TMS therapy typically costs $6,000–$12,000 for a full treatment course. However, since TMS is FDA-approved for depression, it is often covered by insurance, including Medicare and Medicaid.

At True North TMS, our team works with insurance providers to help make treatment as accessible as possible.

Ketamine Costs and Insurance Coverage

Ketamine therapy can become more expensive over time:

• A single IV ketamine session costs $400–$800
• A full initial course requires 6–8 sessions, followed by maintenance treatments

Spravato (esketamine) is FDA-approved, so it is more likely to be covered by insurance than IV ketamine.

TMS vs. Ketamine: Which Treatment is Right for You?

Choosing between TMS and ketamine depends on your unique circumstances, including your unique patient needs and medical history. 

Delivery method:
TMS:

Non-invasive with no anesthesia needed; patients can typically function as normal and drive home straight after treatment
Ketamine:

Injections can be invasive, and close monitoring is required for a given period before a patient can go home; patients can’t drive home afterward

Time for benefits to show:

TMS:

Gradual improvement over weeks

Ketamine:

Rapid relief, often within hours

Long-term results:

TMS:

Sustained improvement after sessions

Ketamine:

Requires ongoing maintenance

Contraindications:

TMS:

Not suitable for those with a history of seizures, neurological conditions and metal implants in the head

Ketamine:

Not suitable for those with history of mania, substance abuse disorders, and cardiovascular disease

Patient diagnosis:

TMS:

Only FDA-approved for depression, OCD, and smoking addiction, but it can be used off-label for other conditions

Ketamine:

Ketamine is used off-label for a variety of conditions, but Spravato is strictly only available for TRD and MDSI

Cost:

TMS:

Often covered by insurance for eligible conditions 
Ketamine:

Often no or limited insurance coverage unless using Spravato

Why Choose TMS at True North TMS in Anchorage, Alaska?

At True North TMS, we specialize in high-quality, personalized care for individuals struggling with depression. Here’s what sets our clinic apart:

• Expert Team: True North TMS is physician-owned and operated, ensuring expert oversight of your treatment plan.
• Tailored Approach: Every patient receives a customized treatment protocol to maximize results.
• Advanced Technology: State-of-the-art TMS equipment provides effective and precise therapy.
• Comprehensive Support: The team helps patients navigate insurance coverage, making the process as smooth as possible.

If you’re considering TMS therapy, True North TMS offers expert care and advanced treatment options to help you take the next step toward recovery. Reach out today to learn more about how TMS can transform your mental health journey.