Resources
Frequently asked questions
Detailed answers about TMS therapy, Esketamine (Spravato), and IM Ketamine treatments. Switch between treatments to see relevant questions.
TMS Therapy questions
What is TMS therapy?
Transcranial Magnetic Stimulation is a non-invasive treatment that uses focused magnetic pulses to stimulate nerve cells in the prefrontal cortex — a brain region involved in mood regulation. The treatment is drug-free, requires no anesthesia, and patients remain awake throughout each session.
What conditions does TMS treat?
TMS is FDA-approved for treatment-resistant depression (since 2008), obsessive-compulsive disorder (OCD), and as an aid for smoking cessation. It is also used off-label for anxiety disorders, PTSD, and certain neurological conditions.
How does a TMS session work?
During a session, you sit in a chair while a magnetic coil is positioned against your scalp near the forehead. The device delivers brief magnetic pulses for 20-40 minutes. You may feel a tapping sensation. Most patients drive themselves to and from sessions and resume normal activities immediately.
How many TMS sessions do I need?
A standard course typically involves 30-36 sessions delivered over 4-6 weeks, usually five days per week. Some newer protocols compress treatment into shorter timeframes. Your treating clinician will design a protocol based on your condition and response.
How quickly does TMS work?
TMS works gradually. Most patients begin to notice improvement in mood, energy, or sleep around 2-3 weeks into treatment. Full effects typically appear by completion of the 4-6 week course. Some patients experience improvements continuing for weeks after treatment ends.
What are the side effects of TMS?
TMS has a mild side-effect profile. The most common are scalp discomfort or tingling at the treatment site during sessions, and occasional mild headache afterward. Both typically diminish after the first few sessions. Serious side effects (seizures) are very rare — about 1 in 30,000 sessions.
Is TMS covered by insurance?
Most major insurance providers cover TMS for treatment-resistant depression in adults, including Medicare and most commercial plans. Coverage typically requires prior authorization with documentation that you have tried two or more antidepressant medications without adequate response. Medicaid coverage varies by state.
How much does TMS cost without insurance?
A full TMS course (30-36 sessions) generally ranges from $6,000 to $15,000 depending on the clinic, location, and protocol used. With insurance and met deductibles, copays per session typically range from $0 to $50.
Who is not a candidate for TMS?
TMS is not recommended for people with non-removable metal implants in the head (excluding standard dental work), a history of seizure disorders, severe head injury, or certain neurological conditions. Pregnancy is generally a precaution rather than a strict contraindication. A consultation with a TMS provider determines candidacy.
Can I keep taking my medications during TMS?
Yes, in most cases. Many patients continue their existing antidepressants during TMS treatment. Your prescribing physician and TMS provider should coordinate to ensure your medication regimen is optimized.
What happens after TMS treatment ends?
Many patients experience continued improvement after the acute treatment course ends. Some patients benefit from periodic maintenance sessions (typically monthly) to sustain remission. If symptoms return, additional acute courses are often effective.
Can TMS be combined with therapy or medication?
Yes. TMS is often most effective as part of a comprehensive treatment plan that includes psychotherapy, ongoing medication management, and lifestyle interventions. Most clinics encourage continued therapy during and after the TMS course.
Esketamine (Spravato) questions
What is Esketamine (Spravato)?
Esketamine is the S-enantiomer of ketamine, formulated as a nasal spray and sold under the brand name Spravato. It was FDA-approved in 2019 for treatment-resistant depression in adults, and in 2020 for major depressive disorder with acute suicidal ideation or behavior.
How is Spravato different from regular ketamine?
Spravato is the S-enantiomer of ketamine, while standard ketamine contains both R and S forms. Spravato is FDA-approved, administered as a nasal spray under medical supervision at REMS-certified clinics. IV or IM ketamine is used off-label and administered as an injection or infusion. Both work on similar brain pathways but have different protocols and insurance coverage.
How does an Esketamine session work?
You receive the nasal spray under medical supervision at a REMS-certified clinic. After self-administering the spray, you must stay at the clinic for at least two hours of monitoring. Most patients receive treatment twice per week for the first four weeks, then weekly or biweekly during a maintenance phase.
How long is the full Esketamine treatment?
An induction phase typically lasts 4 weeks (twice-weekly dosing), followed by a maintenance phase that can last several months to years depending on response. Your treating clinician will determine the appropriate length based on your symptoms and progress.
How quickly does Spravato work?
Spravato often produces noticeable effects within hours to days — significantly faster than oral antidepressants, which typically take 4-6 weeks. Some patients experience meaningful improvement after their first session; others require several sessions before benefits become apparent.
What are the side effects of Esketamine?
Common side effects include dissociation (feeling disconnected from yourself or surroundings), dizziness, nausea, drowsiness, and elevated blood pressure during the session. Effects typically resolve within two hours. Less common side effects can include anxiety, vomiting, or vertigo. The clinic monitors you for these effects.
Is Spravato covered by insurance?
Most major insurance providers cover Spravato for FDA-approved indications, with prior authorization required. Documentation of prior antidepressant trials is typically necessary. Medicare covers Spravato. Coverage details vary — verify with your specific plan.
How much does Spravato cost?
With insurance and met deductibles, copays generally run $50-$300 per session. Without insurance, sessions typically range from $400 to $900. Janssen Pharmaceuticals (the manufacturer) offers patient assistance programs that may reduce out-of-pocket costs.
What is REMS certification?
Risk Evaluation and Mitigation Strategy (REMS) is an FDA program required for certain medications with specific safety considerations. Spravato can only be administered at REMS-certified clinics, where patients are monitored for at least two hours after each dose. This ensures safe handling of the medication and proper patient supervision.
Can I drive after Spravato treatment?
No. Spravato causes dissociation and can impair motor function and judgment. You should arrange for a ride home and avoid driving or operating machinery for the rest of the day after each session.
Who is not a candidate for Spravato?
Spravato is not recommended for people with aneurysmal vascular disease, arteriovenous malformations, history of intracerebral hemorrhage, or known hypersensitivity to esketamine. Caution is required for people with certain heart conditions, history of substance use disorder, or who are pregnant. A consultation determines candidacy.
Can I take other antidepressants with Spravato?
Yes — Spravato is FDA-approved to be taken alongside an oral antidepressant. In fact, the standard treatment regimen includes both. Coordinate with your prescribing physician and the Spravato provider to ensure your medications work safely together.
IM Ketamine questions
What is IM Ketamine therapy?
Intramuscular (IM) ketamine is the use of ketamine — administered as an injection into a muscle — to treat conditions like treatment-resistant depression, PTSD, and certain anxiety disorders. It is used off-label, meaning the FDA has not specifically approved ketamine for these psychiatric uses.
How is IM Ketamine different from Spravato?
Spravato is FDA-approved Esketamine, given as a nasal spray under strict REMS-certified protocols. IM Ketamine is the original ketamine compound, given as an intramuscular injection, used off-label for psychiatric conditions. IM Ketamine is generally less expensive per session but rarely covered by insurance because of its off-label status.
What conditions does IM Ketamine treat?
Most commonly used for treatment-resistant depression. Off-label uses also include PTSD, severe anxiety disorders, certain chronic pain conditions, and obsessive-compulsive disorder. Ketamine is also used in emergency settings for acute suicidality, though typically by IV route.
How does an IM Ketamine session work?
After clinical evaluation, you receive a single intramuscular injection of ketamine, typically in the arm or thigh. You then rest in a comfortable space (often with eye covers and music) under medical monitoring for 1-2 hours as the effects unfold and resolve. Patients typically receive a series of sessions over several weeks.
How quickly does IM Ketamine work?
Antidepressant effects often begin within hours to days — much faster than oral antidepressants, which typically take 4-6 weeks. Some patients experience significant improvement after the first session; most require multiple sessions to achieve sustained benefit.
How many IM Ketamine sessions are needed?
A typical induction protocol involves 4-8 sessions over 2-4 weeks. Some patients then enter a maintenance phase with sessions every few weeks or monthly. Your treating clinician will personalize the protocol based on your response and condition.
What are the side effects of IM Ketamine?
Common side effects during sessions include dissociation, altered perception, dizziness, nausea, and elevated blood pressure. These typically resolve within 1-2 hours. Less common effects can include anxiety during the experience or vomiting. Long-term frequent use can carry risks; reputable clinics use carefully spaced protocols.
Is IM Ketamine covered by insurance?
IM Ketamine for psychiatric use is rarely covered by insurance because it is administered off-label. Most patients pay out-of-pocket. Some clinics work with healthcare financing companies (e.g., CareCredit) or accept HSA/FSA payments. Some insurers may cover the medical management fee but not the medication.
How much does IM Ketamine cost?
Per-session costs typically range from $300 to $700. A full course of treatment (induction plus initial maintenance) generally ranges from $2,500 to $6,000+. Costs vary by clinic, location, and protocol.
Can I drive after IM Ketamine?
No. IM Ketamine causes dissociation and impairs motor function and judgment. You must arrange transportation home and should not drive, operate machinery, or make important decisions for the rest of the day.
Is IM Ketamine safe?
When administered in a clinical setting by qualified providers, IM Ketamine has an established safety record for short-term, supervised use. Cardiovascular risks (elevated blood pressure during sessions) are managed through medical monitoring. Long-term frequent use carries different risks and should be carefully managed by an experienced clinician.
Who is not a candidate for IM Ketamine?
IM Ketamine is not recommended for people with active psychosis, untreated severe substance use disorder, severe cardiovascular disease, certain liver conditions, increased intracranial pressure, or pregnancy. A thorough medical evaluation is essential before starting treatment.
The information above is for educational purposes only and is not a substitute for medical advice. Discuss your specific situation with a qualified healthcare provider before starting any treatment.