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Decision Guide

TMS, Spravato, or Ketamine — Which One Is Right for Me?

The three interventional options for depression, compared honestly — cost, coverage, speed, time commitment, and who each one actually suits.

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Written by the Bishop Health clinical team · Medically reviewed by Tamer Wassef, MD
Published August 15, 2026 · Last reviewed August 15, 2026

For most people with treatment-resistant depression, start with the covered options: TMS if you want a drug-free treatment with no downtime, Spravato if faster relief matters and you can arrange rides. Ketamine infusion acts fastest but is self-pay only. Bishop Health delivers TMS and Spravato — infusion is not offered here — and an evaluation tells you which fits your history.

Side by Side, Honestly

TMS Spravato (esketamine) Ketamine infusion (IV)
Offered at Bishop Health Yes Yes No — not offered at Bishop Health
Insurance coverage Commercial + MaineCare, prior auth Commercial + MaineCare, prior auth Not covered — self-pay only
Typical out-of-pocket Copays per session once authorized Copays; manufacturer assistance often applies Full course is self-pay, quoted up front
How fast it works Weeks 2–4 of the course Often within 1–2 weeks Hours to days — fastest
Time commitment ~20 min/day, 5 days/wk, 6–9 weeks ~2.5 hrs/visit, 2×/wk then weekly ~2 hrs/visit, 6 infusions over 3 weeks
Can you drive yourself? Yes — no sedation, no downtime No — ride required, no driving until next day No — ride required, no driving until next day
Main side effects Scalp discomfort, early headaches Dissociation, nausea, BP rise — monitored Dissociation, nausea, BP rise — monitored
Evidence base FDA-approved since 2008; large trials FDA-approved for TRD (2019); phase-3 trials Strong studies; off-label for depression
Often best for Working people who can't lose afternoons; medication-fatigued patients TRD needing faster relief with insurance coverage Severe depression where speed is critical and self-pay is workable

A Simple Way to Think It Through

If you're asking…

"Can I fit treatment around my job?"

TMS: 20-minute sessions, drive yourself, straight back to work. The daily rhythm becomes routine by week two.

TMS in detail →
If you're asking…

"I need relief soon and I need insurance to pay."

Spravato: FDA-approved for TRD, often felt within weeks, covered with prior auth — plan for rides and 2.5-hour visits.

Spravato in detail →

Real answer: your medication history, health screening, coverage, and logistics decide this together — that's what the evaluation is for. It's one conversation, and it frequently changes which option people start with.

Comparison Questions, Answered

Can I try one and switch if it doesn't work?

Yes — that's the advantage of both living in one practice. A TMS non-response can pivot to Spravato without a new referral, new records, or a new evaluation from scratch.

Are Spravato and ketamine infusion basically the same drug?

Chemically related, practically different: Spravato is esketamine, nasal, FDA-approved for TRD, and covered; infusion is racemic ketamine, IV, dosed by weight, off-label, and self-pay. Response profiles overlap but aren't identical.

Do any of these replace my antidepressant or therapy?

Usually they run alongside — Spravato is approved specifically with an oral antidepressant, and therapy amplifies durability for all three. Your prescriber coordinates the whole picture.

Which has the best long-term results?

No honest clinic ranks them universally — durability varies by person. TMS responses often hold months to a year with boosters available; Spravato supports ongoing maintenance dosing; infusion responses are fastest but typically need planned boosters.

What would you recommend for someone on MaineCare?

Start with TMS or Spravato — MaineCare covers both with prior authorization, and we handle that paperwork. Ketamine infusion is self-pay for everyone, MaineCare included.

Is one safer than the others?

All three have strong safety records in screened patients — the screening is the point. TMS avoids systemic drug effects entirely; the ketamine-based options involve monitored, transient blood-pressure and dissociation effects. Your health history decides which risks matter.