Struggling with depression that doesn’t respond to medication or therapy? You’re not alone. Treatment-resistant depression (TRD) affects millions of people, but new, FDA-approved options like TMS and Spravato are offering real hope and life-changing results.

Understanding Treatment-Resistant Depression

Depression is one of the most common mental health conditions in the United States, but for many people, standard treatments like antidepressants and talk therapy are not enough. Treatment-resistant depression (TRD) is typically diagnosed when a patient has tried at least two different antidepressant medications without significant improvement.

TRD can be overwhelming. It may lead to:

• Persistent sadness and hopelessness
• Disrupted sleep patterns and fatigue
• Difficulty concentrating or functioning at work and home
• Loss of interest in activities once enjoyed
• Increased risk of suicidal thoughts

If this sounds familiar, know that you are not alone—and that other options exist.

What Is TMS (Transcranial Magnetic Stimulation)?

TMS (Transcranial Magnetic Stimulation) Treatment is a noninvasive, FDA-approved treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. Unlike medication, TMS directly targets underactive neural pathways in the brain that contribute to depression.

What to Expect with TMS Treatment

• Outpatient sessions, typically 5 days a week for 4–6 weeks
• A magnetic coil is placed on the scalp to deliver painless stimulation
• No anesthesia or downtime required—patients can return to daily activities immediately

Benefits of TMS

• Non-medication option for those who cannot tolerate antidepressants
• Long-term symptom relief after a full course of treatment
• Few side effects (most common are mild scalp discomfort or headache)

TMS therapy offers lasting changes to brain activity, helping patients regain energy, motivation, and emotional stability without the daily side effects of medications.

What Is Spravato (Esketamine)?

Spravato® (esketamine) is an innovative, FDA-approved nasal spray derived from ketamine. Originally approved in 2019 as an add-on to antidepressants, in 2025 the FDA expanded approval for Spravato therapy to be used as a stand-alone treatment for TRD.

How Spravato Works

• Targets glutamate receptors in the brain, improving communication between neurons
• Helps the brain form new connections that restore healthy mood regulation
• Can begin reducing symptoms of depression within 24 hours of the first dose
  

What to Expect During Spravato Treatment

• Administered in a certified clinic under medical supervision
• Patients remain in a comfortable setting for 2–3 hours after dosing to monitor side effects
• Treatment is usually given twice a week for the first month, then tapered based on response

Common Side Effects: Mild dissociation, dizziness, drowsiness, or nausea. These typically resolve within hours.

TMS vs. Spravato: What’s the Difference?

Both treatments are powerful options for TRD, but they work in different ways:

• TMS: Stimulates the brain externally using magnetic pulses; safe, non-invasive, and effective for long-term change.
• Spravato: Administered internally through nasal spray; works quickly to reduce symptoms, even within hours or days.

When used together, TMS and Spravato may offer the best of both worlds: rapid relief from Spravato plus long-term stability from TMS.

5 Signs You Might Have Treatment-Resistant Depression

Wondering if TMS or Spravato might be right for you? Here are signs you may be living with TRD:

1. You’ve tried two or more antidepressants without improvement.
2. Medication side effects (weight gain, sexual dysfunction, fatigue) make it hard to continue.
3. Talk therapy alone hasn’t eased your symptoms.
4. Your depression severely impacts daily life, relationships, or work.
5. You feel stuck, hopeless, or fearful that nothing will help

If these sound familiar, it may be time to explore advanced treatments.

Breaking Through Depression: Why This Matters

For too long, patients with TRD have had limited options. The approval of Spravato as a stand-alone treatment and the proven long-term benefits of TMS mean that patients now have real, science-backed alternatives when standard treatments fail.

At Georgia Behavioral Health, we’re proud to offer both TMS and Spravato to our community—because no one should have to live with the weight of untreated depression.

JNJ.com – Spravato (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression.

JAMA Psychiatry, July 2025 – Esketamine Monotherapy Outperforms Placebo for TRD.