Exploring Ketamine vs.TMS for Depression

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). While these new developments offer more treatment options for people living with treatment-resistant depression, it can be challenging to determine which intervention is best suited for you, leading to the question we hear a lot at Hudson Mind: Ketamine vs. TMS—which is the best treatment option for depression?

These advanced therapies have proven to be effective for reducing symptoms of complex mental health conditions, like treatment-resistant depression. And there is no cut-and-dry answer to the question: ketamine vs. tms?

Both of these treatment resistant depression therapies can help to significantly reduce depressive symptoms. But depending on your medical history, symptoms, and lifestyle, you may find that one treatment suits your needs better than the other. 

What is ketamine therapy?

Ketamine is a dissociative anesthetic that was approved by the FDA in 1970 for general anesthesia during surgery. But in recent years ketamine has gained widespread recognition for its rapid 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.

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). 

*Considered an off-label therapy

Ketamine vs.TMS: what does the research say?

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. 

Potential Side Effects

Despite their efficacy, both Ketamine Therapy and TMS Therapy have limitations and considerations that patients and clinicians should be aware of. 

Ketamine, although generally safe when administered in a clinical setting, may cause transient dissociative effects, elevated blood pressure and heart rate, and nausea. 

TMS Therapy, while considered safe and well-tolerated, may cause mild side effects such as headache or scalp discomfort during treatment sessions. 

Ketamine Therapy and TMS Therapy represent significant advancements in the treatment of severe depression. 

Ultimately, choosing between Ketamine Therapy and TMS Therapy depends on the patient.