How do these two groundbreaking treatments compare?
Advancements in psychiatric care have ushered in a new age of mental health care, anchored by two groundbreaking treatments: Ketamine Therapy and Transcranial Magnetic Stimulation (TMS). These new developments create more treatment avenues for people living with treatment-resistant depression, but because of their relative novelty, it is challenging for some patients to determine which intervention is best for them.
While there is no one-size-fits-all answer to the ketamine vs TMS debate, you may find that one treatment suits your needs better than the other depending on your medical history, symptoms, and lifestyle.
This article covers the mechanisms of action, efficacy, and potential side effects to consider as you pursue one (or both) of these interventions.
What is ketamine therapy?
Ketamine is a dissociative anesthetic that was approved by the FDA in 1970 for general anesthesia during surgery. But over the course of the past decade ketamine gained more mainstream recognition for its fast-acting antidepressant effects.
Ketamine therapy is administered in several ways:
- Ketamine infusion therapy
- Ketamine intramuscular injections
- Ketamine (Spravato) nasal spray
- Ketamine oral tablets
What is TMS therapy?
Transcranial Magnetic Stimulation (TMS) is another groundbreaking treatment for depression that targets specific areas of the brain using magnetic pulses.
During a TMS session, an electromagnetic coil is placed against the scalp, delivering focused magnetic pulses to the specific regions of the brain.
Patients interested in TMS can choose from several protocols, including Standard, Deep TMS, and accelerated (SAINT) TMS. Deep TMS refers to TMS machines that feature specialized coils, capable of reaching deeper structures in the brain with electromagnatic pulses.
Ketamine vs TMS: mechanisms of action
How does ketamine relieve symptoms of depression?
Chemical messengers in the brain, also known as neurotransmitters, are involved with regulating mood and emotion. But chronic stress and depression disrupts the chemical messengers being sent back and forth between nerve cells, making it more difficult for regions of the brain to communicate.
Low-dose ketamine treatments may promote neuroplasticity by first stimulating the production of the neurotransmitter Glutamate which then stimulates BDNF, a protein involved in regulating synapses (the connections between neurons).
These neurobiological changes help the brain form new pathways, which can also help patients with treatment resistant depression break free from depressive thought patterns and form new cognitive habits.
While traditional antidepressant medications can take weeks to take affect, ketamine has been shown to alleviate depressive symptoms within hours.
How does TMS relieve symptoms of depression?
During TMS treatment, patients wear a helmet that has specially designed the electromagnetic coil configurations to target areas of the brain associated with mood regulation.
The coils in the helmet emit MRI-strength magnetic pulses to rejuvenate and regulate neurotransmitters affected by chronic stress and depression in the brain. By employing magnetic stimulation, previously inactive or deficient neurotransmitters are essentially revitalized.
Furthermore, these pulses trigger synaptic plasticity and neurogenesis in the hippocampus, fostering improved communication between different brain regions.
It’s important to note that TMS is not a one-time treatment—patients who follow a standard protocol undergo 36 sessions over the course of 8-10 weeks. (Sessions typically last between 8-22 minutes).
| Ketamine | TMS | |
| Conditions | Depression, anxiety, bi-polar | Depression, OCD, Substance-use disorder* |
| Non-invasive? | Yes | Yes |
| Side effects | Dizziness, nausea | Headaches, scalp pain, jaw pain, muscle twitch |
| Insurance coverage? | No | Yes |
Ketamine vs TMS: Efficacy
Both Ketamine Therapy and TMS Therapy have shown promising results in the treatment of depression, particularly in individuals who have not responded to traditional antidepressants. However, their efficacy profiles and treatment modalities differ.
Ketamine Efficacy
Research indicates that a 6-week ketamine protocol elicits a 50% response rate and a 20% remission rate. Further, 10 infusions elicits a 72% response rate and a 38% remission rate. One of the benefits of ketamine is that many patients may feel some symptom reduction within a week (or sooner). And studies have shown that a single ketamine infusion reduces thoughts or suicide or self-harm within 24 hours. Though a single treatment may be helpful, psychiatrists recommend following a full protocol (at least 6 infusions) for longer lasting symptom reduction.
TMS Efficacy
Research indicates that 30 sessions of Deep TMS can elicit an 85% response rate and 65% remission rate. Additionally, an accelerated TMS protocol (SAINT) developed by Stanford University School of Medicine has been shown to elicit a 79% remission rate. During this accelerated protocol, patients receive 50 TMS treatments in the span of 5 consecutive days.
Ketamine vs TMS: potential side effects
Ketamine potential Side Effects
Ketamine, although generally safe when administered in a clinical setting, may cause the following mild side effects:
- Elevated blood pressure
- Elevated heart rate
- Nausea
- Loss of appetite
- Disorientation
TMS potential side effects
TMS Therapy, while considered safe and well-tolerated, may cause the following mild side effects:
- Scalp pain
- Headache
- Tingling
- Facial twitching or spasms
- Lightheadedness
While this article gives you a general overview of both ketamine and TMS for depression, we always recommend consulting with a doctor. Treatment-resistant depression is never a one-size-fits-all condition, and some people may experience more success with certain interventions or combinations of interventions.
Questions?
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