Ketamine, Spravato, or TMS: The Pros and Cons of Each

At Breakthru Psychiatric Solutions in Sandy Springs, Georgia, we understand that depression can be a debilitating condition that negatively impacts all aspects of your life. That's why we offer a range of advanced treatment options, including IV ketamine, Spravato®, and transcranial magnetic stimulation (TMS).

Dr. Karen Giles, our highly experienced interventional psychiatrist, is an early adopter of these innovative, emerging treatments. She is certified in administering IV ketamine and Spravato (esketamine), and Dr. Giles offers the latest protocols of TMS.

Here’s a comparison of the three treatments:

IV Ketamine

IV ketamine has been used for over 50 years as an anesthetic but, in recent years, has been studied as a treatment for depression. According to a meta-analysis published in the Journal of Affective Disorders in 2020, ketamine has rapid antidepressant effects that you can feel within hours of administration. Additionally, the study found that ketamine effectively treated patients who had not responded to traditional antidepressant therapies.

However, it's important to note that both the form of ketamine administered as well as the setting it is administered in have tremendous impact on the efficacy of treatment. Dr. Giles carefully monitors each patient for possible side effects; she personalizes doses for safety and success; and she creates an individual taper plan for each patient to ensure lasting results.

Ketamine pros and cons at a glance

Pros:

Rapid antidepressant effects: As mentioned, IV ketamine has rapid antidepressant effects, which can benefit patients who have not responded to other treatments.
Minimal Side Effects: IV ketamine may cause mild side effects of nausea, headache, dizziness, increase in blood pressure and heart rate, and dissociation, all of which are temporary and only occur during infusion.
Combine Treatments: While waiting for prior authorization from insurance companies for TMS or Spravato, Breakthru can start patients with IV ketamine as a way to quickly and effectively address the most severe symptoms of chronic depression.

Cons:

Not Covered by Insurance: IV ketamine is not covered by insurance. Patients pay out of pocket for this treatment.
Side effects: Ketamine can cause hallucinations, dissociation, and other side effects in some patients. These side effects are temporary and only present during treatment. Dr. Giles includes integration time to make sure all patients feel safe and stable before leaving the clinic.
Risk of abuse: Although the risk of addiction is low, if you have a history of substance abuse, you may be at a higher risk of abuse when using ketamine. There is some data that suggests people with a family (not personal) history of alcohol use disorder may benefit from ketamine for their depression.

Spravato

Spravato is a nasal spray that contains esketamine, a derivative of ketamine, and is FDA-approved for treatment-resistant depression as an augmentation to any oral antidepressant. A randomized clinical trial published in JAMA Psychiatry in 2019 found that, compared to a placebo, Spravato effectively reduced depressive symptoms in patients with treatment-resistant depression and depression with suicidal ideation when taken with an oral antidepressant.

Although Spravato is highly effective, it can also have temporary side effects, such as dissociation and dizziness. At Breakthru Psychiatric Solutions, we believe in informed choice and work closely with you to decide on the best course of treatment based on your individual needs and preferences.

Spravato pros and cons at a glance

Pros:

Rapid antidepressant effects: Like IV ketamine, Spravato has rapid antidepressant effects.
Less invasive: Unlike IV ketamine, which is administered via intravenous infusion, Spravato is a nasal spray, which can be less intrusive for some patients.
Covered by Insurance: Spravato is FDA-approved, and many insurance companies will cover the cost of this treatment.

Cons:

Side effects: Spravato can cause similar side effects to IV ketamine, such as hallucinations and dissociation, although often at lower levels since this is a refined form of ketamine. These side effects are temporary and only present during treatment. Dr. Giles includes integration time to make sure all patients feel safe and stable before leaving the clinic.
Time Commitment: Like IV ketamine, patients need to plan to be in the office for about 2 hours for each treatment and must have someone to drive them home afterward.
Insurance Requirements: While it varies by insurance company, most companies require that the patient has tried 2 - 3 different depression medications from at least 2 different drug classes that failed (did not work) and continue taking an oral antidepressant while undergoing Spravato treatments.

Transcranial magnetic stimulation

TMS is a noninvasive treatment that uses electromagnetic pulses to stimulate regions of the brain associated with depression. In several studies, including one published in the Journal of Clinical Psychiatry in 2019, TMS effectively reduced depressive symptoms in patients who had not responded to traditional antidepressant therapies.

While TMS has minimal side effects, it is a time-intensive treatment that typically involves 30-minute sessions five days a week for six weeks, followed by a 3-week taper protocol. Dr. Giles also offers accelerated TMS and helps you navigate your options to ensure your treatment fits your lifestyle and schedule and is as effective as possible.

TMS pros and cons at a glance

Pros:

Non-invasive: TMS is a non-invasive treatment option that does not require anesthesia or hospitalization.
Long-lasting effects: TMS has long-lasting effects, with some patients experiencing remission for up to a year.
Minimal side effects: TMS has minimal side effects, the most common being a mild headache or scalp discomfort during treatment.

Cons:

Time-Consuming: A typical TMS treatment course involves 30-minute sessions five days a week for six weeks, followed by a 3-week taper protocol.
Cost: Traditional TMS is often covered by insurance; however, accelerated TMS is not currently covered by insurance.
Time to Results: While TMS offers excellent results, it does take longer to experience symptom relief than if you were using IV ketamine or Spravato. Patients using traditional TMS typically experience symptom reduction in about 4 weeks. Patients following an accelerated protocol typically experience symptom reduction by day four.

All three treatments have proven effective in reducing depressive symptoms, especially for those with treatment-resistant depression, but it's important to discuss with Dr. Giles the potential risks and benefits of each treatment option based on your individual needs.

Call Breakthru Psychiatric Solutions in Sandy Springs, Georgia, or use our online booking tool to schedule a consultation.