Your patient sits across from you with a printout from WebMD and a lot of anxiety. She’s tried three antidepressants. Nothing stuck. Her therapist mentioned “newer treatments,” and now she’s asking questions you’re not entirely sure how to answer:

“Is Spravato® a drug? Because I’ve heard of ketamine, and I’m confused.”

“How many sessions does TMS take? Will I have to come in every day?”

“What’s the difference between these treatments, and which one works better?”

These aren’t edge cases. These are the core questions your coordinator and clinical team field dozens of times per month. And if your answers aren’t standardized, accurate, and consistent—you’re losing qualified patients to clinics that can explain these treatments clearly.

This guide breaks down what your patients actually need to understand about treatment-resistant depression options, so your team can answer with confidence and authority.

“Is Spravato® a medication or a procedure?”

What patients are really asking: Is this something I swallow, inject, or do at a clinic?

The answer:

Spravato® is a nasal spray medication, specifically esketamine, which is a form of ketamine. However, it’s not something you take at home. You receive it at a clinic under medical supervision.

Here’s the key distinction: Unlike oral antidepressants you manage yourself, Spravato® treatments happen in a controlled clinical setting where your vital signs are monitored throughout and after administration. This is a critical safety feature, not an inconvenience.

The protocol looks like this:

  • Frequency: Twice per week for 4 weeks (8 sessions), then once per week for 4 weeks (4 sessions), then once every two weeks for 4–12 weeks (depending on response)
  • Total acute phase: 12 sessions over 8 weeks
  • Per-session duration: 45 minutes to 1 hour (15 minutes for administration, 45 minutes monitoring afterward)
  • You stay in the clinic: No driving for at least 5 hours after treatment. Most patients need someone to pick them up.

Why it’s supervised: Spravato® can temporarily raise blood pressure, cause dissociation, dizziness, and drowsiness. The clinic monitors these effects to ensure safety. After 2–4 hours, most side effects resolve.

Critically important: Spravato® is always prescribed alongside an oral antidepressant. It’s not a replacement for medication—it’s an enhancement. This is often the detail patients miss, and it changes their expectations about what to expect.

“What exactly happens during a TMS session?”

What patients are really asking: Will this hurt? What does it feel like? Why do I need so many sessions?

The answer:

TMS (Transcranial Magnetic Stimulation) is not a medication—it’s a device-based treatment that uses magnetic pulses to stimulate specific regions of the brain associated with depression.

Session experience:

  • What you do: Sit in a comfortable chair. A magnetic coil is placed against your scalp (usually the left prefrontal area). The device produces a tapping sensation on the scalp.
  • What it feels like: A rhythmic tapping, sometimes compared to a woodpecker. Not painful, but noticeable. Some patients describe mild discomfort, though it’s usually tolerable within 1–2 sessions.
  • Session length: 19–40 minutes, depending on the protocol (standard rTMS is 20–30 minutes)
  • Frequency: 5 sessions per week, typically Monday–Friday
  • Total course: 20–36 sessions over 4–6 weeks (standard protocol)
  • You drive yourself: No sedation, no monitoring period. You can go straight to work after treatment.

Why so many sessions? TMS works through cumulative neuroplasticity. The magnetic pulses gradually strengthen connections in brain regions linked to mood regulation. A single session does nothing. 5 sessions do something small. 20 sessions create measurable change. This is why discontinuing early typically results in symptom relapse.

Maintenance TMS: After the acute phase, many patients benefit from maintenance sessions: 1–2 times per week for 2 weeks, then biweekly for 2 months, then monthly. Maintenance reduces relapse rates from 30–40% to around 10–15%.

Key patient concern: “Will I have to do this forever?” Answer: Most patients need maintenance for 6–12 months. Some go years with just monthly touchups. Others stop after the acute phase and do well. It’s individual.

“How long until each treatment works?”

What patients are really asking: When will I feel better? Do I have to wait weeks?

The answer—and here’s where these treatments differ significantly:

Spravato® (fastest onset):

  • Some patients notice improvement within 1–2 treatments
  • Most see meaningful change by 4–6 treatments
  • Most significant response by week 4–8 of the acute protocol
  • This rapid effect is why Spravato® is often used for patients with active suicidal ideation—it can provide relief when oral medications are too slow

TMS (moderate timeline):

  • Rarely noticed in the first 1–2 weeks
  • Many patients report initial changes around week 3–4
  • Maximum benefit typically by week 6–8 of the acute phase
  • Some patients plateau after 4 weeks, requiring continuation to full 36 sessions for maximal effect

Ketamine IV infusions (fastest onset):

  • Some patients report dramatic shifts within 2–4 hours of the first infusion
  • Most experience noticeable change by 2–4 infusions
  • Full response often by 4–6 infusions
  • Rapid effect makes ketamine valuable for acute crises, but effects can be short-lived without maintenance

Why the difference? Spravato® and ketamine work faster because they act on the glutamate system directly, bypassing the serotonin pathway that traditional antidepressants (and TMS indirectly) target. They’re essentially different biological mechanisms.

Patient expectation to set: “Faster doesn’t always mean better long-term. Spravato® may feel better sooner, but TMS often produces more stable, durable relief. We’ll monitor your response and adjust.”

“What are the side effects? And will they last?”

What patients are really asking: Will I feel weird? Will I be able to work?

TMS side effects (minimal and short-term):

  • Scalp discomfort/tapping sensation: Usually resolves by week 2
  • Headache: Occurs in 5–10% of patients, typically mild, responds to over-the-counter pain relievers
  • Facial twitching: Rare, mild when it occurs
  • Seizure: Extremely rare (less than 0.1%)
  • Rare serious effect: Mania in patients with bipolar disorder (why screening is critical)

Bottom line for TMS: Side effects are mild and temporary. Most patients tolerate treatment well enough to work during their course.

Spravato® side effects (temporary but more pronounced):

  • Dissociation: Feeling disconnected from reality. Common but typically resolves within 2–4 hours
  • Dizziness/vertigo: Feeling the room is spinning. Usually passes within 1–2 hours
  • Nausea: Occurs in 20–30% of patients, usually mild
  • Increased blood pressure: Can spike 20–30 minutes after administration, typically normalizes within 2–4 hours
  • Drowsiness/sedation: Common for the first few hours
  • Euphoria or altered mood: Some patients feel a pleasant “high”—this is normal and passes
  • Hallucinations: Rare
  • Dissociation lasting longer than a few hours: Rare, but patients should report this immediately

Why Spravato® requires monitoring: These side effects are why patients can’t drive and need 45 minutes to 1 hour of clinical monitoring after each dose. The clinic is there to catch serious reactions (like hypertensive crisis) should they occur.

Ketamine IV infusion side effects (similar to Spravato®):

  • Dissociation: Common during infusion, controlled by medical staff
  • Dizziness/nausea: Temporary, managed with anti-nausea medication beforehand
  • Increased heart rate and blood pressure: Monitored throughout infusion
  • Euphoria: Common, part of the treatment experience for some clinics
  • Confusion post-infusion: Temporary, why monitoring and driving restrictions are essential

“How much does each treatment cost?”

What patients are really asking: Can I afford this? Will insurance cover it?

This is where you need to be direct and honest. Insurance coverage varies wildly by plan, and most patients are shocked by out-of-pocket costs.

TMS cost (most insurable):

  • Per session: $300–$800 (facility fees vary by location)
  • Full acute course (30 sessions): $9,000–$24,000 out-of-pocket without insurance
  • With insurance: Often $0–$500 per session after deductible, because most major insurers now cover TMS for treatment-resistant depression
  • Maintenance sessions: Similar per-session cost

Spravato® cost (insurance dependent):

  • Medication cost without insurance: $800–$1,200 per dose
  • Facility monitoring cost: $400–$600 per session
  • Total uninsured per session: $900–$1,800
  • Full acute protocol (12 sessions) uninsured: $10,800–$21,600
  • With insurance: Eligible patients often pay $10–$60 per session after deductible
  • Caveat: Insurance approval can be challenging. Many insurers require documentation that patient has failed 2+ oral antidepressants first

Ketamine IV infusion cost (least insurable):

  • Per session: $400–$1,200 (highly variable by region and facility)
  • Standard initial course (6–8 infusions): $2,400–$9,600 out-of-pocket
  • Insurance coverage: Most plans do NOT cover ketamine for depression (FDA approval is only as an anesthetic). Some plans will partially reimburse if ketamine is deemed medically necessary after failure of other treatments, but this is rare
  • Maintenance infusions: $400–$1,200 per session, usually out-of-pocket

Real patient translation: “TMS is most likely to be covered by insurance. Spravato® can be covered if insurance approves it (which isn’t guaranteed). Ketamine is almost never covered by insurance. Before starting any treatment, we’ll verify your coverage and give you a clear out-of-pocket estimate.”

“Which one actually works better?”

What patients are really asking: Why would I choose one over the other if they all treat depression?

The honest answer: Response rates are surprisingly similar, but the clinical contexts are different.

TMS efficacy:

  • Response rate (50% symptom reduction): 50–60%
  • Remission rate (90% symptom reduction): 30–40%
  • Time to maximum effect: 6–8 weeks
  • Durability: Excellent with maintenance. 6–12 months of maintenance sessions can sustain relief for years
  • Best for: Patients who prefer a non-medication approach, have medical complexity (multiple medications), or need sustained long-term benefit

Spravato® efficacy:

  • Response rate: 60–70%
  • Remission rate: 30–50%
  • Time to maximum effect: 4–8 weeks
  • Durability: Good, but some patients experience symptom return if maintenance lapses
  • Best for: Patients with active suicidal ideation (rapid effect), those needing quicker relief, patients who’ve already tried multiple medications

Ketamine IV efficacy:

  • Response rate: 60–70%
  • Remission rate: 30–50%
  • Time to maximum effect: 1–4 weeks (fastest)
  • Durability: Can be short-lived. Many patients need frequent maintenance (weekly to biweekly infusions) to sustain benefit
  • Best for: Acute suicidal crisis (fastest relief), patients who need rapid intervention, patients in research or specialized centers

The real distinction: It’s not which works “better”—it’s which is right for your clinical situation, preferences, and constraints.

Specific patient scenarios:

Patient A: “I want something that doesn’t involve medications and doesn’t require ongoing visits.” → TMS is ideal. Do 36 sessions, then transition to maintenance (1x/month). Can eventually discontinue.

Patient B: “I need to feel better fast. I’m thinking about hurting myself.” → Spravato® or ketamine. Both work faster than TMS. Spravato® is more accessible (more clinics offer it).

Patient C: “I have 5 different medications and I’m concerned about drug interactions. I want something clean.” → TMS. No medication interaction concerns. No need to stop current medications.

Patient D: “I’ve failed multiple antidepressants and TMS doesn’t work for me. What’s next?” → Spravato® or ketamine. Different mechanism. Can work when other approaches fail.

“Can I combine treatments?”

What patients are really asking: Can I do TMS AND Spravato® at the same time? Or one after the other?

The answer: Yes, with caveats.

Combination approaches:

TMS + Oral Antidepressant (standard):

  • Most common approach
  • Oral antidepressant provides baseline control; TMS provides targeted brain stimulation
  • Effective combination. Synergistic in many cases

Spravato® + TMS (sequential):

  • Some patients start Spravato® for rapid response (weeks 1–8), then switch to TMS for long-term maintenance
  • Or vice versa: TMS acute phase, then Spravato® maintenance if needed
  • Increasingly used but requires careful coordination

TMS + Ketamine (concurrent):

  • Rarely done, usually only in research settings
  • Theoretical benefit but unproven
  • Added burden (more frequent clinic visits)

Spravato® + Ketamine (rarely concurrent):

  • Both work on glutamate system
  • Combined approach generally avoided due to overlapping mechanism and safety concerns
  • Sequential approach (one, then the other if needed) more common

What to tell your patient: “We typically start with one primary treatment and monitor response closely. If one isn’t working by 4–6 weeks, we might combine it with another, or switch to a different approach. We’ll stay flexible based on how you respond.”

“What’s the difference between clinic-based and at-home treatments?”

What patients are really asking: Can I do this at home? Do I have to come to your office every time?

The answer:

TMS: Clinic-based. No at-home option. Must come in 5 days per week.

Spravato®: Clinic-based. Always administered in a medical facility under supervision. No at-home version approved by FDA. (Generic ketamine nasal sprays exist at-home, but these lack FDA oversight, have higher misuse risk, and are not recommended.)

Ketamine IV: Clinic-based. Requires IV administration, medical monitoring, transportation restriction.

Ketamine IM (intramuscular): Clinic-based, though some specialized providers offer it. Requires injection, monitoring, transportation restriction.

Ketamine lozenges (sublingual): At-home option, but off-label use, not FDA-approved, variable dosing, misuse potential. Not recommended for standard clinical care.

Real translation: “These aren’t like taking a daily antidepressant at home. All three require regular clinic visits for the acute phase. That’s actually a safety feature and a clinical advantage—we monitor you, adjust dosing, and catch side effects early.”

Why Your Team Needs Standardized Answers

Here’s the critical point: If your front desk coordinator tells a patient “TMS takes 4 weeks,” and your clinical team tells another patient “TMS takes 6 weeks,” and a third patient hears “TMS can take up to 12 weeks,” you’ve just created confusion and reduced confidence.

Each inconsistency is a potential lost patient.

The patient will call a competitor’s clinic, get a clearer answer, and switch.

This is especially true for treatment-resistant depression patients. They’ve already failed multiple treatments. They’re anxious. They want clear, consistent information. If your clinic can’t provide that, they’ll find one that can.

Standardized answers don’t mean robotic scripts. They mean your team knows:

  • The typical TMS protocol (5x/week for 6 weeks, 30 sessions, 20–30 minutes each)
  • The typical Spravato® protocol (2x/week for 4 weeks, then 1x/week for 4 weeks, 12 sessions total)
  • The typical ketamine protocol (6–8 infusions over 2–4 weeks, then maintenance)
  • Common side effects and their timelines
  • Insurance coverage reality for each
  • Why these treatments differ and when each is appropriate

When your team can answer these questions with confidence, consistency, and clinical accuracy—you’re not just providing information. You’re building authority. You’re showing that your clinic understands these treatments deeply enough to explain them clearly.

And you’re converting qualified leads into committed patients.

The Bottom Line

Your patients don’t need complex neuroscience. They need clear, accurate, consistent answers to straightforward questions:

  • What is this treatment?
  • How does it work?
  • How long will it take?
  • What will I feel like during/after?
  • How much will it cost?
  • Why would I choose this over that one?

Train your team to answer these questions accurately. Create a simple reference guide that everyone uses. Quiz your coordinators monthly to ensure consistency.

Then watch your conversion rates improve.

Because when patients feel informed and confident—when they understand what they’re signing up for—they stop second-guessing and start committing to treatment.

That’s when you stop losing leads to competitor clinics.

That’s when your clinic becomes the one patients recommend to others.

And that’s when TMS, Spravato®, and ketamine aren’t just treatment options—they’re pillars of your clinical authority.