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TMS Or Ketamine: Which Is More Effective? Breaking Down The Two Alternative Treatments

TMS Or Ketamine: Which Is More Effective? Breaking Down The Two Alternative Treatments

Transcranial magnetic stimulation (TMS) and ketamine are two alternative treatments for a range of mental health conditions. But which is more effective, TMS therapy or ketamine? To answer this question, we have to examine the most up-to-date evidence on these treatments, as well as the practical differences between the two. But first, let’s provide a quick summary of what these two treatments involve.

Looking for ketamine therapy? Click here to find top rated ketamine clinics near you

What Is Ketamine Therapy?

Ketamine therapy involves taking a sub-anesthetic dose of ketamine in a clinical, supervised setting. It is useful for treating conditions such as the following.

  • Major depressive disorder
  • Treatment-resistant depression
  • Suicidality
  • Post-traumatic stress disorder (PTSD)
  • Addiction
  • Anxiety

When you undergo ketamine therapy, you can have a single infusion or multiple infusions. Many studies on ketamine treatment for depression find good results using a round of six infusions. Many ketamine clinics follow this protocol. You will receive ketamine at a clinic via either intravenous (IV) or intramuscular (IM) infusion, although the former is the most common route of administration.

It is also possible to take ketamine orally or as a nasal spray, which you administer yourself outside of a clinical setting.

RELATED: The Best TMS Therapy Clinics in Los Angeles, California

What Is TMS Therapy?

TMS therapy is a non-invasive procedure that uses magnetic energy pulses to stimulate certain areas of the brain. This is meant to correct abnormalities in those brain areas affected in cases of the below.

  • Major depressive disorder
  • Treatment-resistant depression
  • Anxiety
  • PTSD

If opting for TMS therapy, the treatment will involve visiting a specialized clinic, and sitting comfortably in a chair while a device delivers magnetic pulses to stimulate brain areas responsible for mood regulation, such as the prefrontal cortex. The treatment comes in the form of single-pulse TMS (sTMS), which delivers a very brief magnetic pulse, or repetitive TMS (rTMS), in which magnetic impulses are delivered at regular intervals.

As with ketamine, many people opt for TMS therapy when other treatments fail. Many people also have multiple sessions with TMS as a way to increase the efficacy of the treatment.

How Effective Is Ketamine Therapy?

Ketamine is effective at treating many mental disorders, particularly depression. Let’s highlight some of the most important research on ketamine therapy.

With ketamine, the above benefits are generally rapid and significant, with improvements in mental health persisting for up to two weeks.

Looking for ketamine therapy? Click here to find top rated ketamine clinics near you

How Effective Is TMS Therapy?

TMS is also effective at treating the above conditions, with some high-quality research providing the following results.

  • rTMS leads to moderate improvements of symptoms for patients with major depressive disorder or treatment-resistant depression.
  • rTMS leads to a significant decrease in suicidality in depressive patients.
  • Through rTMS, patients with mild or moderate depression achieve remission from depression at a much higher rate than those with severe depression. This particular study, published in Frontiers in Psychiatry, also found that the total number of TMS sessions was not a predictor of remission.
  • rTMS appears to significantly reduce the core symptoms of PTSD.

With TMS, patients notice results usually after two weeks. Meanwhile, the durability of the benefits depends on the particular condition. In the case of PTSD, for instance, research indicates improvements can last at least 2-4 weeks. However, when it comes to depression, most TMS patients feel better for many months after the end of treatment, with the average length of response being just over a year. Antidepressant effects are more likely to be sustained in depressive patients who are non-psychotic, treatment-resistant, less severely ill, and taking antidepressants after TMS therapy.

Differences Between Ketamine And TMS

There are also many crucial differences between ketamine therapy and TMS therapy, which may matter to you.

Length Of Treatment

Ketamine: Patients typically have 6-10 infusions.
TMS: Patients usually sign up for 30-36 sessions.

The Length Of Each Session

Ketamine: The session lasts around 60-75 minutes.
TMS: The session lasts 25 to 50 minutes.

How You Will Feel During The Treatment

Ketamine: At sub-anesthetic doses, this compound can cause a range of psychoactive effects, including dissociation, visual and auditory distortions, hallucinations, euphoria, confusion, and anxiety.
TMS: This treatment does not result in any psychoactive effects and during treatment, you are able to have a conversation and read as normal.

Insurance

Ketamine: Insurance will cover a portion of your treatment but not the entire infusion.
TMS: Insurance can cover your treatment.

RELATED: Ketamine Therapy vs. Antidepressants: What Are The Pros And Cons Of Each?

Continuing Your Current Medications

Ketamine: Some psychiatric medications interact with ketamine, so this may affect whether you are able to stay on your medication as you undergo ketamine therapy.
TMS: Medications are safe to use in combination with TMS. Many patients continue to take their antidepressants when beginning TMS therapy.

The Verdict

So which is better: TMS or ketamine? Based on the above differences between the two treatments, this answer will depend on your priorities.

In terms of efficacy, ketamine has much more rapid effects compared to TMS, whereas the latter treatment seems to have longer-lasting benefits. For this reason, TMS may be better suited if you have chronic symptoms of depression. But if you are seeking fast-acting relief, especially if you have suicidal depression, then ketamine may be preferable over TMS since the benefits of the latter can take weeks to appear.

Practically, TMS will involve a greater commitment of your time compared to ketamine. But this may not be more costly if your insurance provider covers your TMS treatment. If you are looking for a mental health treatment without a psychedelic experience and side effects, then TMS is likely to be more appealing. Also, if you want to continue taking psychiatric medication during treatment, this is likely to be easier if you opt for TMS rather than ketamine.

It’s worth underscoring, however, that you don’t necessarily have to choose between ketamine and TMS. It’s possible to combine these treatments. And research has indicated that this combination is effective, reducing depressive symptoms in patients with treatment-resistant depression for two years. Of course, combining treatments can involve a greater commitment of time and money.

It’s best to consider together the research on these treatments, your personal preferences, and your individual circumstances. This will help you arrive at a decision that makes the most sense to you.

Sam Woolfe

View all posts by Sam Woolfe

Sam Woolfe is a freelance writer based in London. His main areas of interest include mental health, mystical experiences, the history of psychedelics, and the philosophy of psychedelics. He first became fascinated by psychedelics after reading Aldous Huxley's description of the mescaline experience in The Doors of Perception. Since then, he has researched and written about psychedelics for various publications, covering the legality of psychedelics, drug policy reform, and psychedelic science.

Abid Nazeer

This post was medically approved by Abid Nazeer

Dr. Nazeer is the Founder and President of APS Ketamine/Advanced Psychiatric Solutions, which he established in 2016 as the first psychiatric outpatient ketamine clinic in Illinois. He is board certified in Psychiatry as well as Addiction Medicine. He completed his psychiatry residency at Louisiana State University Health Sciences in Shreveport where he held the role of Chief Resident. Dr. Nazeer is providing medical oversight to the growth plan of Wesana Clinics, with the model of comprehensive psychiatry clinics specialized ketamine and psychedelic therapies, integrated brain health and wellness centers, and technology utilization of Wesana Solutions remote patient monitoring product.

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