If you’ve tried antidepressants without success, you’ve likely come across two commonly recommended next steps: ketamine therapy and TMS (Transcranial Magnetic Stimulation). Both are FDA-recognized treatments for depression. Both are available in the San Diego area. And both have helped patients who conventional medications could not. So how do you know which one is right for you?
This guide — written from the perspective of a physician who performs ketamine therapy — aims to give you an honest, comparative look at both treatments so you can make an informed decision.
Transcranial Magnetic Stimulation uses powerful magnetic pulses delivered through a coil placed against the scalp to stimulate specific brain regions involved in mood regulation — most commonly the left dorsolateral prefrontal cortex (DLPFC). The treatment is non-invasive, requires no anesthesia or sedation, and is performed while the patient sits in a chair, fully awake and alert.
A standard TMS course involves approximately 36 sessions delivered five days per week over six to seven weeks. Newer accelerated protocols (like the Stanford SAINT protocol) compress this timeline significantly, though these remain less widely available.
Ketamine therapy involves the physician-supervised administration of sub-anesthetic doses of ketamine — via IV infusion, IM injection, or intranasal esketamine (Spravato) — to rapidly modulate glutamate signaling and promote neuroplasticity. A standard initial series involves six infusions over two to three weeks.
Ketamine wins decisively for speed.
Ketamine is one of the fastest-acting antidepressants known. Many patients notice meaningful mood improvement after the first or second infusion — sometimes within hours. For patients in acute distress or with active suicidal ideation, this rapid onset can be clinically critical and sometimes lifesaving.
TMS typically requires two to four weeks of consistent treatment before patients notice significant improvement, with full benefit often not apparent until the final week of the course or after completion.
Both treatments have robust evidence. Ketamine is supported by decades of research starting with landmark work at the NIH, with hundreds of trials documenting rapid antidepressant effects. TMS received FDA clearance for depression in 2008 and has a well-established body of real-world evidence.
For treatment-resistant depression specifically, both treatments show comparable response rates — roughly 50–70% of appropriate candidates experience meaningful improvement.
TMS tends to produce more durable remission on average.
A completed TMS course can produce remission lasting six to twelve months or longer without ongoing treatment. Maintenance sessions are available if symptoms return.
Ketamine’s effects, while rapid, typically require maintenance infusions for many patients over time. That said, individual variation is significant — some patients maintain benefit for months or more after an initial series without ongoing treatment.
Neither treatment is typically covered by standard insurance for depression (Spravato/esketamine is an important exception — it does have insurance coverage pathways for TRD at certified treatment centers).
TMS sessions are brief (20–40 minutes), require no sedation or recovery time, and patients can drive themselves and return to normal activity immediately. For patients who can accommodate five days per week for six weeks, it is minimally disruptive.
Ketamine infusions require a driver (no driving for 24 hours post-session), last 1–2 hours including monitoring, and are typically scheduled twice weekly during the initial series. The treatment window is more compressed, which some patients prefer.
TMS involves sitting in a chair while a clicking magnetic coil stimulates the brain. The experience is essentially non-experiential — patients remain fully alert and often read, watch content, or simply wait.
Ketamine produces a dissociative, immersive experience that patients describe in many ways: sometimes profoundly meaningful, occasionally visually rich, often deeply calming or restorative. This experience is not incidental — for many patients, it is a significant part of the healing mechanism.
Yes. TMS and ketamine are not mutually exclusive. Some patients have tried one and subsequently tried the other. Others use both in combination or sequence. The potential synergy of ketamine’s neuroplasticity promotion with TMS’s targeted brain stimulation is an area of active interest in psychiatric research.
At Seaside Ketamine, we are transparent about both options. We will never advocate for ketamine if TMS appears to be the more appropriate fit for your specific situation — your outcomes matter more than the treatment chosen.
