For many Australians struggling with treatment-resistant depression, finding an effective therapy can feel like a long journey. Two cutting-edge options now available are Transcranial Magnetic Stimulation (TMS) and Spravato (esketamine nasal spray).
While both have shown promising results, each works in different ways, has distinct benefits, and tends to suit different patient needs. Understanding the differences between Spravato and TMS can help you make a confident choice about your treatment.
An Introduction to Spravato and TMS
What Is TMS?
TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in areas of the brain linked to mood regulation. It’s typically administered in regular sessions at a clinic, with no medication involved. TMS is well-suited for patients who prefer to avoid drugs or who have experienced unwanted side effects from antidepressants.
What Is Esketamine (Spravato)?
Esketamine is a fast-acting nasal spray approved for adults with treatment-resistant depression who have not responded to at least two antidepressant treatments. Unlike traditional antidepressants, it targets the brain’s glutamate system, promoting quicker symptom relief.
Spravato is delivered in a controlled clinic environment under medical supervision due to its potent effects and potential side effects.
Comparing Effectiveness: TMS and Spravato
Both TMS and Spravato have proven successful in reducing depressive symptoms when standard therapies have failed. While the treatment has an induction phase and several ongoing treatments, 50 to 65% of patients respond positively to esketamine, often with rapid improvement within days.
TMS also shows favorable response rates, with approximately 45% to 60% of patients experiencing significant improvement and around 30% to 40% achieving remission after a course of treatment. However, reaching these benefits typically requires a series of daily sessions over a period of 4 to 6 weeks, usually five times per week.
Side Effects and Safety
TMS is generally well-tolerated with mild side effects such as scalp discomfort or headaches.
Esketamine can cause dissociation, increased blood pressure, dizziness, and sedation, which is why it must be administered under supervision with post-treatment monitoring. You can learn more about Spravato side effects here.
Cost Considerations
When considering esketamine vs TMS, your decision may be influenced by cost considerations.
Esketamine treatment costs have significantly decreased since its inclusion on the Pharmaceutical Benefits Scheme in 2025, reducing the medication cost to $31.60 per dose for most patients. However, clinic fees for administration and monitoring, usually $300 to $350 per session, still apply. Psychiatrist consultations are billed separately and may be partially covered by Medicare.
For a detailed breakdown, see our guide to Spravato cost.
TMS sessions typically cost between $150 and $300 per visit, varying by clinic and session frequency. Unlike esketamine, TMS doesn’t involve medication costs.
Comparing TMS and Spravato Side by Side
Here’s a quick comparison of TMS and Spravato that breaks down how each treatment works, what to expect during sessions, possible side effects, costs, and who might benefit most from each option:
| Feature | TMS (Transcranial Magnetic Stimulation) | Spravato (Esketamine Nasal Spray) |
| How It Works | Uses magnetic pulses to stimulate brain areas linked to mood | Nasal spray affecting glutamate system for rapid relief |
| Treatment Setting | Outpatient clinic, no medication | Administered in clinic under medical supervision |
| Treatment Duration | Daily sessions for 4 to 6 weeks | Twice weekly for 4 weeks, then tapered maintenance |
| Common Side Effects | Mild headaches, scalp discomfort, fatigue, nausea | Dissociation, dizziness, sedation, nausea, increased blood pressure |
| Cognitive Effects | None reported | Temporary confusion or dissociation is possible |
| Drug Interactions | None | Must be administered with an antidepressant |
| Post-Treatment Recovery | No downtime, can drive immediately | Requires monitoring for 2+ hours post-dose, no driving |
| Cost Consideration | $150-$300 per session, no medication cost | $31.60 per dose PBS subsidised + $300-$350 clinic fees |
| Ideal For | Patients preferring non-medication, minimal side effects | Patients needing rapid symptom relief, medically supervised |
Weighing Up TMS and Spravato
Both TMS and Spravato offer effective options for treatment-resistant depression, but they differ in important ways that might make one a better fit depending on your preferences and lifestyle.
You might prefer TMS if you’re looking for a medication-free approach, want to avoid drug-related side effects, or value a treatment with minimal recovery time after sessions. Since TMS sessions are typically daily over a few weeks and don’t require post-treatment monitoring, it can fit well into a busy schedule for those who can commit to regular clinic visits.
On the other hand, Spravato may be the better choice if you want faster symptom relief and don’t mind the in-clinic administration with supervision. Its unique rapid-acting nature can be life-changing for many people, especially those dealing with severe symptoms. However, it does require monitoring after each dose and involves some side effects that need professional oversight.
Which is Right For You?
Ultimately, the best choice between Spravato and TMS depends on your personal treatment preferences and your doctor’s recommendations. Your psychiatrist will consider your medical history, symptom profile, and lifestyle to guide you toward the most suitable therapy.
In some cases, psychiatrists may even recommend integrating both treatments to provide the best possible outcomes, known as using TMS and Spravato together.
Having an open conversation with your healthcare provider is key to finding the right path for you.
Accessing Spravato and TMS Treatment at Mind Oasis
Mind Oasis provides expert care for both esketamine and TMS therapies within a supportive, patient-centred environment.
Our Esketamine Clinic in Sydney offers safe, supervised treatment with experienced psychiatrists and nursing staff. However, we also provide telehealth psychiatry services and TMS across Australia, with psychiatrists in Canberra, Sydney, Melbourne, Brisbane, and Adelaide to support your journey no matter where you live.
Making Your Choice
Choosing between TMS vs esketamine, or deciding to do both, requires informed decision-making based on your medical history, lifestyle preferences, treatment goals – and of course, what your psychiatrist recommends.
Whatever your situation, our compassionate team is here to help guide you through these options with personalised advice and care.
If you’re curious about which treatment might be right for you or want to explore combining therapies, contact Mind Oasis today to schedule a consultation.
Your path to effective, modern treatment for depression starts here.