Ketamine vs. TMS: Which treatment is best for me?

Ketamine and Transcranial Magnetic Stimulation (TMS) are both cutting-edge treatments being used by psychiatrists and other mental health providers for depression and other mood disorders. At Principium Psychiatry, we are proud to have both of these treatments available to our patients. But what distinguishes these two treatments? Both treat medication-resistant depression, but what are the differences between each treatment, and how do I know which one is best for me? Below are answers to our most frequently asked questions regarding both of these novel therapies.

How long does it take to work?

Ketamine: Although this varies by patient, we usually start seeing the effects of Ketamine on mood after 2 or 3 infusions. However, for a longer lasting effect, patients usually need at least 6 infusions. The response rate for Ketamine is quite high, with 70% of patients showing improvement in depressive symptoms.

TMS: On average, patients report improvement in mood, concentration, and energy levels at around 2-4 weeks of treatment. Timeline of improvement varies from patient to patient, with some noticing changes in mood as early as the 15th session, while others may not notice improvement until closer to the end of the treatment course. Based on scientific literature and data from our practice, about 70% of patients respond to the treatment.

How long is the treatment course?

Ketamine: The number of infusions needed vary by patient and by depression severity. We recommend an initial treatment with 6-10 infusions over the span of 2-4 weeks. Then, a maintenance phase is recommended with booster infusions every 2-4 weeks to maintain a continued effect on mood.

TMS: The standard TMS treatment course for major depression is 36 sessions, conducted daily on weekdays. Depending on individual patients, additional 10-15 sessions may be recommended to reach full therapeutic effect. Patients have the option to return for maintenance sessions 6-8 weeks following completion of full treatment course on a need basis.

How long is each session?

Ketamine: The Ketamine dose, calculated for each individual based on his or her weight, is given over 60-75 minutes in one-fourth increments. We encourage patients to stay in our office for an additional 10-15 minutes after the infusion is completed to ensure there are no lingering side effects.

TMS: Each TMS session lasts 25 to 50 minutes depending on the protocol being used. Patients may be prescribed modified treatment protocols depending on individual symptoms.

How will I feel during the session?

Ketamine: Most patients find Ketamine infusions to be very relaxing and enjoyable. The most common perceivable effects during infusions are: sleepiness/drowsiness, feelings of relaxation and euphoria, heightened perceptions (colors and sounds are more intense), feeling of mild intoxication, and feelings of  “a weight being lifted” or “being reset”. Please see our blog post about this topic: “What Does It Feel To Get A Ketamine Infusion”

TMS: Patients sit in a comfortable reclining chair. The patient’s head is secured with light padding and the magnetic coil is placed against the head. The coil then will deliver the treatment pulses twice per minute for the duration of treatment. During TMS sessions, patients are awake and alert, able to carry conversations, watch television, listen to music, or read. No medication is used, and patients are able to drive afterwards.

Does insurance cover this treatment?

Ketamine: Insurance will cover a portion of the ketamine treatment procedures but will not cover the entire infusion.

TMS: TMS is covered under all major private insurance companies including Blue Cross Blue Shield, United Healthcare, Aetna, Cigna, and Oxford. For other questions regarding costs, insurance coverage, and reimbursement, please call our office at 212-335-0236.

Is the treatment FDA approved?

Ketamine: Ketamine is not currently FDA approved for the treatment of depression (although we predict it will be within the next few years). However, ketamine has been FDA approved as an anesthetic since 1970. It is a safe medication and off-label use of medications is common practice within the medical community.

TMS: Yes, TMS is an FDA-approved treatment for major depressive disorder. The Neurostar Advanced Therapy TMS device was the first to receive FDA approval in October 2008 for use in treatment-resistant depression, and most TMS treatment studies have used the Neurostar. BrainsWay, a Jerusalem-based manufacturer of TMS device, received FDA approval in 2013, and in 2015, MagVenture also received FDA approval for its MagVita TMS Therapy System. At Principium Psychiatry, we use the Neurostar Advanced Therapy device.

Can I continue my current medications?

Ketamine: There are few psychiatric medications that interact with Ketamine. During your initial consultation, you will need to disclose what medications (including supplements) you regularly take to ensure there will not be any interactions during treatment.

TMS: Yes, medications are safe to use in combination with TMS. Many patients continue taking their antidepressants when beginning TMS treatment. Over the course of treatment, as the mood improves, medications can be simplified or tapered off. If you are taking benzodiazepines, such as Xanax, Klonopin, Ativan, or Valium, the dose may need to be adjusted prior to starting TMS. Your medications list would be discussed during your initial consultation.

How do I decide between each treatment?

For those seeking fast-acting relief, ketamine may be recommended over TMS. On the other hand, TMS may be more suited for those who have certain chronic symptoms of depression such as poor concentration and inability to take pleasure in daily activities.

At Principium Psychiatry, Dr. Cohen will go over both treatments with you during your initial consultation, and will make a recommendation based on his clinical expertise and knowledge of these treatments and what your personal goals are for your mood and symptoms.

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