Spravato vs TMS: how to choose
Spravato (esketamine) is a nasal spray with a response window of days to 2 weeks, visits of 2.5 hours, and driving held until the next day. Insured sessions run $10 to $250, and treatment continues weekly or biweekly. TMS (transcranial magnetic stimulation) uses 20 to 40 minute visits over six weeks, then usually ends. Insured TMS runs $20 to $90.
Updated · Checked by the Covered Mind editorial team against cited sources
Both are FDA approved and insured for treatment-resistant depression. They differ in schedule, side effects, who qualifies, and what maintenance looks like.
Key facts
- Last checked:
- Sources listed: 2
- Reading time: About 2 minutes
- Spravato response: Days to 2 weeks
- Spravato visit: 2.5 hours
- TMS visit: 20 to 40 minutes
- Insured TMS cost: $20 to $90
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 2 |
| Reading time | About 2 minutes |
| Spravato response | Days to 2 weeks |
| Spravato visit | 2.5 hours |
| TMS visit | 20 to 40 minutes |
| Insured TMS cost | $20 to $90 |
How Spravato and TMS differ
Spravato acts fast and requires ongoing sessions with dissociation and a two-hour observation each time. TMS takes six weeks of short daily visits with no drug effects and often no maintenance for a year or more. Insurance covers both after two failed antidepressants. Check Spravato and TMS coverage in the coverage checker and read coverage rules by insurer. For the session schedule and common questions in one place, see the Spravato overview.
Side by side
| Spravato | TMS | |
|---|---|---|
| Mechanism | Esketamine nasal spray, NMDA receptor | Magnetic stimulation of prefrontal cortex |
| Speed of response | Days to 2 weeks | 3 to 4 weeks |
| Schedule | 2 per week for a month, then weekly or biweekly ongoing | Daily for 6 weeks plus taper, then usually done |
| Visit length | 2.5 hours | 20 to 40 minutes |
| Side effects | Dissociation, nausea, blood pressure rise, sedation | Scalp discomfort, headache |
| Driving | Not until the next day | No restriction |
| Oral antidepressant | Required by most insurers | Not required |
| Exclusions | Uncontrolled hypertension, aneurysm, pregnancy, psychosis | Seizure disorder, metal in head |
| Insured cost per session | $10 to $250 | $20 to $90 |
| Maintenance | Ongoing sessions | Re-treatment only on relapse |
When is Spravato the better fit?
You need a fast response (severe symptoms, suicidal thoughts), you can commit to regular clinic visits with a ride, and you tolerate dissociation. It is also the choice when you cannot have TMS because of metal implants or seizure history.
When is TMS the better fit?
You want a course with an end date, you drive yourself, you prefer no drug effects, or you have cardiovascular issues that make ketamine-type drugs risky. It is also easier to fit around work.
Read TMS vs ECT: what each is for.
For bipolar depression, read Spravato for bipolar depression and TMS for bipolar depression.
Can you do Spravato and TMS together?
Many clinics offer both, and some patients use Spravato for rapid relief while starting TMS for durability. Insurers evaluate each authorization separately; they do not generally pay for both at the same time without a clinical rationale.
Find clinics offering Spravato or TMS therapy, and check your plan on the coverage hub. Read Spravato: the complete guide and TMS: the complete guide.
Related reading: Treatment-resistant depression: what the criteria actually mean and Maintenance for Spravato, ketamine and TMS.
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "Spravato vs TMS: how to choose." https://www.coveredmind.com/compare/spravato-vs-tms. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.