No single treatment is best for depression that has not responded to medication. We choose between TMS, Spravato and ketamine by looking at your history, your health, your schedule and your coverage, and we make the decision with you. This page explains how that works at Village TMS.
Or call (646) 817-2835 to speak with our team
Medically reviewed by Yuli Fradkin, MD, board-certified psychiatrist · Last reviewed October 2026
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Dr Fradkin helped me with treatment-resistant depression using TMS.
Valery Dinner Verified Google ReviewI had a great experience at the Village TMS Center for Autism and Depression. The staff is very kind, professional, and truly cares about their patients. They take the time to listen and explain the treatment process clearly.
kibriyo komilova Verified Google ReviewMy son just finished TMS therapy with Village Group Medical. I am pleased to mention pleasant and welcoming atmosphere of this office. It helped my son relax and agree to undergo the therapy.
Yelena Haskin Verified Google ReviewAs an R.N. for decades I’ve had myriad experiences with institutions and providers. It takes a lot to impress me and that’s what Dr Fradkin and his affable staff have done! My treatments have been attended to with integrity, friendliness and skill. They provided scheduling flexibility, cost transparency, and a comprehensive orientation to my TMS treatments with a smile. Thus I have no reservations advocating Village TMS and award Dr Fradkin and his staff an A+.
Dennis Moriarty Verified Google ReviewI've been using Village Medical Group services for quite some time and can recommend it to everyone. Very easy easy and transparent communications, warm and welcoming office with people who care. George is very knowledgeable, helpful and I really appreciate his help all the time. Dr. Fradkin is amazing specialist that carefully and precisely chose the treatment that helped. I feel safe and comfortable every time I visit the office.
Nikita Khvastunov Verified Google ReviewVery professional and caring team. I enjoyed learning more about this solution and was pleased with the provided service!
Raul Ifraimov Verified Google ReviewTMS session with George went great. Even though I just started and it’s a new experience for me, a cautious supervision and guidance of the specialist helps to get through. I had all my questions being answered before the procedure. Will come again!
Ekaterina Kokovikhina Verified Google ReviewJust had my first TMS session. Feeling great!
Sofia Dro Verified Google ReviewSTEP ONE
Every plan starts with a psychiatric evaluation by one of our board-certified psychiatrists. We confirm the diagnosis and look for anything that can mimic or worsen depression, such as a thyroid problem, a sleep disorder, bipolar disorder or substance use.
Then we go through your medication history in detail: each antidepressant you have taken, the dose, how long you took it, what changed and why you stopped. A trial that was too short or too low a dose is not a true failure. Sometimes the right next step is a better medication trial rather than a new treatment.
Depression is usually called treatment-resistant when it has not improved after at least two antidepressants taken at an adequate dose for an adequate time. Spravato is FDA-approved for this group, and TMS devices are FDA-cleared for adults with major depression who have not improved with antidepressants. Read more about treatment-resistant depression.
A list of past medications and doses if you have one, recent lab results, and the names of your current prescriber and therapist. Gaps are fine; we can fill them in together.
THE THREE OPTIONS
All three are used when standard antidepressants have not been enough, but they work differently and ask different things of you. Each has its own page: TMS, Spravato and ketamine.
FDA-CLEARED DEVICES
Magnetic pulses stimulate mood-related areas of the brain. Sessions take about 20-30 minutes, usually on weekdays. A standard course is usually 30-36 sessions over 6-9 weeks; your psychiatrist sets your schedule. No anesthesia, and you can drive yourself home.
FDA-APPROVED DRUG
A nasal spray you take in our REMS-certified office, followed by at least two hours of monitoring. It is usually given twice weekly in weeks 1-4, weekly in weeks 5-8, then weekly or every two weeks. No driving until the next day, after a restful sleep.
OFF-LABEL USE
Ketamine is FDA-approved as an anesthetic; its use for depression is off-label. It is given by IV infusion or intramuscular injection, with monitoring throughout. IV ketamine typically costs $400-$800 per session and is usually self-pay.
SAFETY FIRST
Some health conditions rule a treatment out or call for extra care. We screen for each of them before we recommend anything.
TMS is generally avoided if you have metal implants in or near the head, such as aneurysm clips or cochlear implants, and it needs careful review if you have a history of seizures. Spravato and ketamine raise blood pressure for a short time after each dose, so uncontrolled high blood pressure and some blood vessel conditions can rule them out.
A history of psychosis usually makes Spravato and ketamine a poor fit, because both can cause dissociation and changes in perception. Past or current substance use matters too, since both carry a risk of misuse; for some people TMS is the safer path. We talk about these things openly. They are part of good care, not a judgment.
SIDE BY SIDE
These are general patterns. Your own answers can differ, which is why we decide together after your evaluation.
| Factor | TMS | Spravato | IV or IM Ketamine |
|---|---|---|---|
|
FDA status |
Devices FDA-cleared for depression that has not responded to antidepressants |
FDA-approved for treatment-resistant depression and for depression with acute suicidal thoughts |
Off-label for depression; FDA-approved only as an anesthetic |
|
Time per visit |
About 20-30 minutes |
Dose plus at least 2 hours of monitoring |
About 40 minutes plus monitoring |
|
Typical schedule |
Weekday sessions; a standard course is usually 30-36 sessions over 6-9 weeks |
Twice weekly in weeks 1-4, weekly in weeks 5-8, then weekly or every 2 weeks |
An initial series, then maintenance if needed |
|
Speed |
Most patients notice improvement within 3-5 weeks |
Some people notice changes within days |
Some people notice changes within hours or days |
|
Driving |
You can drive yourself home |
No driving until the next day, after a restful sleep |
No driving on the day of treatment |
|
Common side effects |
Scalp discomfort or headache, usually easing over the first weeks |
Dissociation, dizziness, nausea, sleepiness, a short rise in blood pressure |
Dissociation, dizziness, nausea, a short rise in blood pressure |
|
Insurance |
Often covered; most patients pay $0-$50 per session with insurance |
More often covered than IV or IM ketamine; usually needs prior authorization |
Usually self-pay; IV typically $400-$800 per session |
Sources: NIMH on brain stimulation therapies and the Spravato REMS program. We verify your coverage for free before you start.
MATCHING THE OPTION
Often fits when you want to avoid medication side effects, need to drive or work on treatment days, can come in on most weekdays for several weeks, and have no metal implants near the head.
Often fits when you want a faster-acting option, can set aside a few hours twice a week at first, have a ride home and have well-controlled blood pressure. It can be used with an oral antidepressant or on its own.
May fit when other options have not worked or are not covered, you accept that its use for depression is off-label, and you have no history of psychosis or substance misuse.
Fits when earlier medication trials were short or low-dose. A well-chosen medication change, with therapy, can still be the right next step.
TRACKING PROGRESS
BASELINE
Before treatment you complete the PHQ-9, a nine-question depression scale validated in published research.
DURING
You repeat the PHQ-9 at set intervals, for example every week or two during a TMS course or the first weeks of Spravato, and we ask about side effects at each visit.
REVIEW
At set points, such as midway through a course, your psychiatrist reviews the trend with you and decides whether to continue, adjust or change approach.
AFTER
When you improve, we plan what comes next: follow-up visits, maintenance sessions if needed, and what to do if symptoms return.
MORE THAN ONE TREATMENT
If you already see a therapist, keep going. With your permission we share updates so your care stays coordinated.
Sofia Dro, MA, offers psychotherapy for individuals and couples at Village TMS. Meet our team.
For some patients, therapy sessions are planned around ketamine treatment. How ketamine-assisted psychotherapy works.
Many patients stay on an antidepressant during TMS or ketamine treatment. Spravato can be taken with an oral antidepressant or on its own.
Straight answers on TMS, Spravato and ketamine.
None is best for everyone. All three can help depression that has not responded to antidepressants. The right choice depends on your medical history, how quickly you need relief, how much time you can give to treatment, whether you can arrange rides home, and your insurance. We make the choice with you after a full evaluation.
Yes. If a treatment is not helping enough after a fair trial, we review your PHQ-9 scores with you and discuss switching or combining. A poor response to one option does not mean the others will fail.
Usually not. Many patients stay on their medication during TMS or ketamine treatment, and Spravato can be used with an oral antidepressant. Never stop a medication without talking to your prescriber.
No. Ketamine is FDA-approved as an anesthetic, and using IV or IM ketamine for depression is off-label. Spravato (esketamine) is a related drug that is FDA-approved for treatment-resistant depression.
TMS and Spravato are often covered when you meet your plan’s criteria, and we handle prior authorization. IV and IM ketamine are usually self-pay. We verify your coverage for free. See TMS costs and ketamine insurance coverage.
Call (646) 817-2835 or contact us to book an evaluation. Bring a list of past medications if you have one.
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