Online Ketamine Treatment Available in: AZ, CA, CO, FL, GA, NY, OR, TX, and WA.
Online Ketamine Treatment Available in: AZ, CA, CO, FL, GA, NY, OR, TX, and WA.
If you have been exploring alternatives to traditional antidepressants, you may have come across both ketamine therapy and transcranial magnetic stimulation (TMS). Both are used for patients who have not responded adequately to conventional treatments, but they work in very different ways. This guide compares the two to help you have a more informed conversation with your provider.
| Factor | Ketamine | TMS |
|---|---|---|
| How it works | Blocks NMDA receptors and modulates glutamate signaling, which may promote neural plasticity | Uses magnetic pulses to stimulate nerve cells in brain regions involved in mood regulation |
| Speed of relief | Some patients report improvement within hours to days | Typically requires 4-6 weeks of daily sessions |
| Administration | Oral/sublingual (at home), IV infusion, or intranasal (in clinic) | In-clinic only; sessions last 20-40 minutes, 5 days/week for 4-6 weeks |
| Cost | Varies widely; at-home oral ketamine may start around $350/appointment + $50-150/mo medication | $6,000-$12,000+ for a full course; some insurance plans cover it |
| FDA status | Ketamine is FDA-approved as an anesthetic; used off-label for depression. Esketamine (Spravato) is FDA-approved for TRD. | FDA-cleared for treatment-resistant depression and major depressive disorder |
| Side effects | Dissociation, nausea, dizziness, elevated blood pressure (typically transient) | Scalp discomfort, headache; rare risk of seizure |
| Evidence level | Growing body of clinical trials and meta-analyses; increasingly used in clinical practice | Well-established with large randomized controlled trials and FDA clearance |
Speed and onset: One of the most notable distinctions is how quickly each treatment may take effect. Ketamine has been associated with rapid mood improvements, sometimes within hours of the first session. TMS, by contrast, generally requires a commitment of daily sessions over several weeks before patients begin to notice changes. For individuals in acute distress, ketamine's potentially faster onset may be a meaningful consideration.
Convenience and accessibility: TMS requires visiting a clinic five days a week for several weeks, which can be challenging for patients with demanding schedules or limited transportation. Oral ketamine therapy, such as the at-home model offered by Isha Health, may be completed from home with telemedicine support, reducing the logistical burden.
Mechanism of action: Ketamine primarily modulates the glutamate system and may promote synaptogenesis, while TMS uses targeted magnetic fields to directly stimulate underactive brain regions. These fundamentally different mechanisms mean that a patient who does not respond to one treatment may still respond to the other.
Insurance and cost: TMS is more likely to be covered by insurance, particularly for treatment-resistant depression. Ketamine used off-label for depression is typically not covered, although HSA and FSA funds can usually be applied. Patients should weigh out-of-pocket costs against the total number of sessions and time commitment required for each option.
Ketamine may produce noticeable mood improvements within hours to days in some patients, whereas TMS typically requires several weeks of daily sessions before patients report meaningful changes. However, individual responses vary significantly.
Some clinicians may recommend combining ketamine and TMS, though research on this combination is still limited. It is important to discuss any combined treatment approach with your provider to understand potential benefits and risks.
A full course of TMS may cost $6,000 to $12,000 or more, though some insurance plans cover it. At-home oral ketamine through Isha Health starts at $350 per appointment plus $50-150 per month for medication. See our pricing page for details.
TMS is more widely covered by insurance for treatment-resistant depression. Ketamine therapy, when used off-label for depression, is generally not covered, though HSA/FSA funds may be used. Spravato (esketamine), which is FDA-approved for treatment-resistant depression, may be covered by some plans.
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