TMS vs Ketamine Therapy: How They Compare
When therapy and medication have not brought enough relief, some people start hearing about “next step” options like Transcranial Magnetic Stimulation (TMS) and ketamine therapy. Both are used for conditions such as treatment resistant depression and sometimes PTSD or anxiety.
I do not provide TMS or ketamine therapy in my practice. I am sharing this for education only, because I do believe these treatments can be helpful for some people and it can feel empowering to understand your options.
If you want the basics before comparing them, you can pair this post with:
What TMS and Ketamine Therapy Have in Common
Both TMS and ketamine therapy are usually considered when:
Someone has tried several antidepressant medications without enough improvement.
There has already been some effort in therapy, but symptoms remain heavy.
There is a desire to avoid or delay more invasive options, such as electroconvulsive therapy.
Both treatments aim to change the way the brain is functioning in order to reduce symptoms such as low mood, hopelessness, lack of motivation, or intense emotional suffering.
They can both:
Be used alongside ongoing psychotherapy
Offer another path when people feel stuck
Require careful medical screening and monitoring
From there, they are quite different.
How They Work in the Brain
TMS therapy
TMS uses focused magnetic pulses on the outside of the head to stimulate specific brain regions involved in mood regulation. Over many sessions, this repeated stimulation is believed to help “reset” patterns of brain activity that are linked with depression and other conditions.
You remain fully awake, and there is no medication moving through your entire system. The effect is local to the area of the brain being stimulated.
Ketamine therapy
Ketamine is a medication. At lower, carefully controlled doses, it affects glutamate and other chemical systems in the brain. It appears to increase neuroplasticity, which means the brain can shift out of rigid patterns more easily.
During a ketamine session, many people experience an altered state of consciousness or changes in perception. The treatment affects the entire brain and body rather than a small targeted area.
In simple terms:
TMS acts from the outside in, using magnetic stimulation on a specific brain region.
Ketamine acts from the inside out, using medication to shift brain chemistry and connections.
How Quickly People May Notice Changes
TMS therapy
TMS is gradual. Some people feel a shift in the second or third week. Others notice changes closer to the end of the treatment series. Improvements might look like:
Slightly more energy
Less heaviness upon waking
More ability to follow through on daily tasks
Progress can be subtle at first and then build over time.
Ketamine therapy
Ketamine can be much faster for some people. There are cases where people report a noticeable change in mood, sense of burden, or suicidal thoughts within hours or days of a session.
The challenge with ketamine is not only whether it works but how long the benefits last. This is why many protocols include a series of treatments followed by maintenance and strong follow up care.
In general:
TMS tends to build slowly and steadily.
Ketamine can have rapid effects, but maintenance planning is essential.
What Sessions Feel Like
TMS sessions
You sit in a chair while a coil rests against your scalp.
You hear clicking sounds and feel tapping sensations on the head.
You stay alert and able to talk the entire time.
You can usually drive yourself home and resume normal activities afterward.
The emotional experience during TMS is often fairly neutral. The main discomfort, when it happens, is usually scalp tenderness or a headache.
Ketamine sessions
You receive the medication by infusion, nasal spray, or another route, depending on the clinic.
You are monitored for safety as the medication takes effect.
You may feel detached from your body or surroundings, have visual or sensory changes, or feel emotions more intensely.
You usually need someone else to drive you home, and you are typically advised not to work, sign important documents, or drive for the rest of the day.
The emotional experience during ketamine can be powerful, meaningful, confusing, or all of the above. Many clinics offer support before and after the session, and some offer therapy during or around the experience to help process what comes up.
Time Commitment and Treatment Schedule
TMS therapy
A common TMS schedule for depression is:
Sessions several days a week
Each session about twenty to forty minutes
A total course lasting about four to six weeks
This often means frequent visits in a short span of time.
Ketamine therapy
Schedules vary based on the form used, but a common pattern might include:
A series of sessions over two to four weeks
Fewer visits per week than TMS, but longer appointments including monitoring time
Follow up or maintenance sessions spaced out over time if it is helpful
So in daily life:
TMS often involves many short visits each week.
Ketamine involves fewer, more intensive visits with recovery time the day of treatment.
Side Effects and Risks
TMS therapy
Common short term effects can include:
Scalp discomfort or tingling
Headache during or right after sessions
Facial muscle twitching during stimulation
Less common but serious risks include seizure, although this is rare when people are properly screened and treated under guidelines.
Because no medication is given, TMS does not carry the same systemic side effects that medications can have, such as weight gain or stomach upset.
Ketamine therapy
Common short term effects can include:
Dissociation or feeling “out of body”
Changes in vision or sound
Nausea or dizziness
Increased blood pressure or heart rate
Fatigue once the session is over
There are also important longer term considerations, such as:
Worsening mood or anxiety in some people
Potential for misuse outside medical settings
Concerns about bladder and cognitive effects with heavy or frequent use over time, especially in non medical contexts
Because of these factors, ketamine should only be used under medical supervision with clear protocols and regular check ins.
In short:
TMS side effects mostly involve local physical discomfort and a small seizure risk.
Ketamine side effects involve both physical and psychological changes and require careful monitoring for safety and misuse.
Insurance Coverage and Access
Coverage depends on the plan, diagnosis, and location, but in general:
TMS therapy
Many insurance companies cover TMS for treatment resistant depression when certain criteria are met, such as having tried several antidepressant medications with limited success. There may be documentation requirements and prior authorizations.
Ketamine therapy
One specific form, intranasal esketamine (often known by the brand name Spravato), can be covered under some plans for treatment resistant depression or depressive symptoms with acute suicidal thoughts. Other ketamine services, such as infusions, are more often self pay, although this can vary.
If someone is considering either treatment, it is important to:
• Ask the clinic how they handle insurance
• Call the insurance company directly
• Clarify any out of pocket costs before starting
How They Fit With Ongoing Therapy
Both TMS and ketamine work best as part of a larger plan, not as stand alone fixes.
Therapy is still important because:
Symptoms are connected to real life experiences, relationships, and stressors.
People need tools to manage triggers and build new patterns.
Big emotional shifts can be confusing without support.
TMS can reduce the heaviness that makes therapy hard to engage in. Once the brain is not as weighed down, it can be easier to do the work.
Ketamine can create a window where people feel more open, less stuck, and more able to see their life from a different angle. Therapy helps make sense of that window and turn insights into real change.
In many ways:
TMS and ketamine can support the brain.
Therapy supports the person living in that brain and body.
Thinking About Which Option Might Fit
Only a medical and mental health team can help someone decide whether TMS, ketamine, both, or neither are appropriate. People might lean toward one or the other based on:
Comfort level with medication versus a device based treatment
Ability to attend frequent appointments
Personal medical history, such as seizure risk or blood pressure issues
How they feel about altered states of consciousness
Insurance coverage and cost
It is completely valid to be curious, explore information, ask questions, and still decide that now is not the right time or that these options are not the right fit.
Final Thoughts
TMS and ketamine therapy are not first steps, but they can be meaningful options for people who have tried many other paths and are still struggling. They each offer a different way of working with the brain, with their own strengths, limitations, and risks.
I do not offer either treatment in my practice and this is not medical advice. My intention is simply to provide clear information so that, if you ever talk with your providers about these options, you feel more prepared and less overwhelmed.
If you are considering TMS or ketamine, it is important to:
Talk honestly with your current therapist or prescriber
Ask detailed questions about safety, expectations, and follow up
Make sure you have emotional support in place before, during, and after any treatment
You deserve care that takes your symptoms seriously and respects your whole story, whether that involves TMS, ketamine, traditional approaches, or some combination of many tools over time.