Is TMS or Spravato Safe? Understanding the Risks and Benefits

When patients do not respond to antidepressants, they may seek alternative treatment options such as Transcranial Magnetic Stimulation (TMS) or Spravato (esketamine). Both of these treatments are changing how we treat depression and have excellent evidence supporting their efficacy. However, like any drug, TMS and Spravato have their own risk and safety profile. We will discuss the risks and safety of both TMS and Spravato, which may help you to better understand each of the treatment options.

What is TMS and Spravato?

Transcranial Magnetic Stimulation (TMS) utilizes magnetic pulses to stimulate specific areas of the brain, targeting the prefrontal cortex, which is associated with mood regulation. It is a non-invasive treatment primarily used for patients with major depressive disorder who have not responded to medications.

Spravato (esketamine) is a nasal spray medication approved to treat patients with treatment-resistant depression. It specifically targets the NMDA receptors within the glutamate system. These receptors, activated by esketamine, help repair and restore synaptic connections in the brain of depressed individuals. Spravato is administered under medical supervision due to its potential side effects.

TMS Safety and Risks

TMS is generally considered a safe treatment option, as most side effects are mild and temporary. The most commonly reported side effects are:

• Scalp discomfort: Some patients may experience mild scalp discomfort or pain during the magnetic pulses.
• Headaches: Usually of short duration and resolve after a few hours.
• Dizziness: Sometimes people can feel dizzy or lightheaded, but these sensations usually don’t last long.

These side effects, mostly well-tolerated, tend to diminish as the therapy goes on.

Serious Side Effects and Risks

Though the chances of severe side effects are rare, they still exist. One of the most serious risks associated with TMS to be aware of is:

• Seizures: Though exceedingly rare, seizures are the most dangerous side effect linked to TMS. This is why doctors don’t suggest TMS for people who have had epilepsy or other brain-related health issues in the past.

Is TMS Safe?

TMS is approved by the FDA and is generally considered safe when performed by a trained clinician.  It has been extensively studied, and there is considerable evidence supporting its efficacy and safety. The treatment is noninvasive and does not require anesthesia, which reduces the possibility of complications. However, TMS is not suitable for everyone. Patients with metal implants on or near their head may not be an acceptable candidate for TMS because of the device’s use of a magnetic field.

Spravato Safety and Risks

Compared to TMS, Spravato has a different side effect profile. Spravato can be very effective for treatment-resistant depression. However, it requires close monitoring because of the nature of the drug. Common side effects include:

• Dizziness: A common side effect reported by many patients, which tends to happen most often immediately after administration of Spravato. Sometimes this feeling will last only a few moments, but it can be unsettling.
• Nausea and Vomiting: A documented side effect in some patients who can experience gastrointestinal symptoms, but which generally resolves in a few hours.
• Drowsiness: Spravato may cause drowsiness or sedation, which is also why it is recommended that patients be observed in a healthcare setting for at least two hours following administration of the medication.

Serious Side Effects and Risks

The more serious side effects of Spravato can be more severe compared to TMS. These include:

• Elevated Blood Pressure: Spravato can spike blood pressure for a short time during therapy. The FDA indicates that while the increase in blood pressure is usually short-duration, it still needs to be monitored, particularly in the case of patients with high blood pressure or heart problems.
• Dissociation: Spravato can create symptoms of dissociation, and patients may feel out of their body or like they are not in their surroundings. These effects are typically short-lived; however, supervision is needed to keep patients safe.
• Abuse Potential: Being a controlled substance, Spravato has an abuse potential. It is chemically similar to ketamine, which is misused recreationally. Patients need to be carefully monitored to prevent misuse.

Is Spravato Safe?

While the FDA has authorized Spravato for patients with treatment-resistant depression, it is not appropriate for everyone. The pharmaceutical company that makes Spravato, Janssen Pharmaceuticals, has recommended that patients be closely monitored in a medical environment during and immediately after Spravato is administered. Due to its sedative and dissociative effects, patients should not drive or operate heavy machinery following treatment.

TMS vs. Spravato: Which is Safer?

In general, TMS and Spravato are both considered safe when conducted properly; however, there are different risk levels between TMS and Spravato.

• TMS is a low-risk, non-invasive procedure that would be a good treatment option for patients looking for a safe, non-medication-based option for depression. However, with the very rare risk for seizures, individuals may choose not to proceed with TMS treatment if they have a history of neurological concerns.
• Spravato provides rapid relief for treatment-resistant depression, but it carries more serious risks, including potential increases in blood pressure, drowsiness, and dissociative features. There are also concerns about abuse risks, which is why it requires careful oversight.

Weighing Risks and Benefits

Both TMS and Spravato provide effective options for people with treatment-resistant depression. While both options have been effective in many cases, it is important to understand the risks and safety profile before making a decision. If you think either TMS or Spravato may be helpful, it is important to talk with a healthcare professional who can review your individual situation and help determine what is the safest and best option for you.

Find Clinics Near You Offering TMS and Spravato

Thinking about exploring TMS or Spravato? Visit MDDCare to find the clinics closest to you that offer these innovative treatments. Our site helps you locate trusted providers ensuring the highest level of care and treatment for your mental health journey.