Ketamine vs. TMS: Which Depression Treatment Is Right for Me?

If you are thinking about suicide or are in crisis, call or text 988 (Suicide & Crisis Lifeline) any time, or call 911. You are not alone.

If you've tried an antidepressant or two and still don't feel like yourself, you've probably come across two newer options: ketamine therapy and transcranial magnetic stimulation (TMS). Both are offered at our Salem clinic, and patients from around the Willamette Valley often ask us the same question: ketamine vs. TMS, which one is right for me?

The honest answer is that it depends on your symptoms, your history, your schedule and your preferences. Neither treatment works for everyone, and neither is "better" across the board. This guide walks through how each one works and what to expect, so you can have a more useful conversation with your provider.

Why look beyond antidepressants?

Most antidepressants work on serotonin and can take several weeks to show whether they're helping. For many people they work well. For others, the relief is partial, the side effects are hard to live with, or nothing changes. When depression hasn't improved after trying more than one medication, it's often called treatment-resistant depression. That's the group both ketamine and TMS have been studied in most closely.

How ketamine therapy works

Ketamine has been used as an anesthetic for decades. At much lower doses, it acts on glutamate, one of the brain's main chemical messengers. Researchers at Yale and elsewhere have found that this appears to help the brain form new connections, which is a different path from serotonin-based medications.

The biggest difference people notice is speed. In clinical studies of IV ketamine for severe, treatment-resistant depression, many participants felt a meaningful lift within about 24 hours. Harvard Health also notes that, for people who respond, ketamine can rapidly ease suicidal thoughts. That doesn't mean one dose is a cure. Experts recommend treating ketamine as part of a broader plan, which may include repeat treatments, therapy and other support.

A few other things to know:

• Off-label use. IV ketamine is FDA-approved as an anesthetic. Using it for depression is off-label, which is common and legal in medicine. A related nasal spray, esketamine, is FDA-approved for treatment-resistant depression.
• What it feels like. During an infusion, many people feel relaxed, floaty or a little detached from their surroundings. Blood pressure can rise for a while, so our team monitors you the whole time. These effects usually fade soon after the infusion ends.
• You'll need a ride. You must have someone drive you home after a ketamine infusion.
• Two formats. We offer IV infusions in the clinic and, for milder symptoms, low-dose oral ketamine taken at home. Your provider will recommend the one that fits you.

Learn more on our ketamine therapy page.

How Exomind TMS works

TMS uses an electromagnetic coil placed against the head to send gentle, repeated magnetic pulses to the areas of the brain involved in mood. According to the National Institute of Mental Health, the magnetic field is about as strong as an MRI's, and the pulses create weak electrical currents that stimulate nerve cells in the targeted area. The FDA cleared the first TMS device for depression in 2008.

We use Exomind, which is FDA-cleared to treat major depressive disorder in adults. Here's what that looks like in practice:

• No medication. Nothing enters your bloodstream, so there are no whole-body drug side effects.
• About 30 minutes per session. You sit in a chair, stay awake and can get on with your day afterward.
• You can drive yourself to and from every appointment.
• A course, not a single visit. TMS works over a series of sessions. Most of our patients finish their course in 4 to 6 weeks, and many notice improvement after about 6 sessions.

The most common side effects NIMH lists are discomfort at the spot where the coil sits, tingling or twitching of the scalp or face muscles during treatment, and mild headaches or lightheadedness. Seizures are possible but rare. Read more on our Exomind TMS page.

Ketamine vs. TMS side by side

• How it works: ketamine is a medication that acts on glutamate. TMS uses magnetic pulses aimed at specific brain regions.
• When people tend to notice change: with ketamine, often within hours to days. With TMS, usually over a few weeks of sessions.
• The visit: ketamine infusions are monitored in the clinic, with time to rest afterward. TMS sessions take about 30 minutes with no downtime.
• Getting home: after a ketamine infusion, someone must drive you. After TMS, you can drive yourself.
• Often a good fit for: ketamine for people who need faster relief from severe or treatment-resistant symptoms. TMS for people who want a drug-free option or would rather not add another medication.

Questions to ask yourself

These questions won't give you a final answer, but they can help you think it through before your visit:

• How urgent does this feel? If your symptoms are severe and you need relief soon, ketamine's speed may matter most. If you are in crisis right now, call or text 988 first.
• How do you feel about medication? If side effects have been a problem before, or you'd like to avoid another medication, TMS may appeal to you.
• What does your week look like? TMS means regular visits over several weeks, but you can drive yourself and go back to work. Ketamine visits take longer, and you'll need someone to drive you home after an infusion.
• What's your health history? Your blood pressure, past seizures, any metal or devices in or near your head, and other conditions can all affect which option is safe for you. Your provider will review this with you.

If you live with bipolar disorder, we still want to see you. People with bipolar disorder are not always good candidates for ketamine or TMS, so we evaluate carefully, and counseling is a good fit for most.

Can you combine them?

Yes, some of our patients use both, and many pair either treatment with counseling. Experts at Yale have noted that ketamine may work best as part of a wider plan, and NIMH notes that research is still sorting out whether TMS works best alone or alongside therapy or medication. Your provider will help you decide what makes sense for you.

What it costs

Every path starts with a $75 consultation, which may be covered by insurance. After that:

• IV ketamine: $450 per infusion. Discounts are often available for full packages and cash pay.
• Oral ketamine: $200–$250.
• Exomind TMS: $350 per session. Insurance coverage for TMS varies significantly by plan, and we can review your options at your consultation.

We also offer patient financing. See every price in one place on our pricing page.

The bottom line

Both ketamine and TMS have real research behind them, and both have helped people in the Salem area who felt stuck. Neither comes with a guarantee, and the right choice is personal. You don't have to figure it out alone. At your consultation, we'll go over your history, answer your questions and help you pick a plan that fits your life.