If you’ve struggled with depression, and traditional antidepressants haven’t given you the relief you need, you’ve probably come across two names again and again: TMS and ketamine. Both treatments have earned real credibility in the psychiatric community, and both offer hope to clients who feel like they’ve tried everything. TMS and ketamine therapy take very different approaches to treating depression, and knowing how they differ can help you figure out which one fits your situation.
At Holme Wellness, we offer both treatments because every patient approach is different. In this guide, we’ll break down how each treatment works, who tends to benefit most from each one, and how to think through the decision so you can walk into your first consultation with confidence.
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What Is TMS Therapy and How Does It Work?
Transcranial Magnetic Stimulation, or TMS, uses targeted magnetic pulses to stimulate specific regions of the brain associated with mood regulation. During a session, you sit comfortably in a chair while a technician positions a magnetic coil near your scalp. The device delivers a series of pulses that activate underactive neural pathways linked to depression.
Unlike medication, TMS doesn’t circulate through your bloodstream. It targets a specific brain region, which is part of why it carries such a mild side effect profile. Most clients tolerate TMS treatment well, and many describe the sensation as a tapping or knocking feeling on the scalp rather than anything painful.
The FDA cleared TMS specifically for treatment-resistant depression, and a growing body of research supports its use for OCD and certain anxiety-related conditions as well. Because it doesn’t involve anesthesia or sedation, you can drive yourself to and from appointments and return to your normal routine immediately afterward.
What Is Ketamine Therapy and How Does It Work?
Ketamine therapy takes a very different approach. Originally developed as an anesthetic, ketamine has shown a remarkable ability to improve mood quickly, especially for clients dealing with treatment-resistant depression, suicidal ideation, or chronic anxiety. Providers typically administer it through IV infusion, intramuscular injection, or sublingual lozenges, and sessions usually happen under close medical supervision in a calm, controlled setting.
Rather than working slowly over weeks like traditional antidepressants, ketamine can create noticeable shifts in mood within hours or days. Researchers believe it works by promoting new neural connections in the brain, which may explain why so many clients experience relief so quickly compared to standard medication.
At Holme Wellness, we build our ketamine program around what we call innovative psychiatry, pairing the medication with integration therapy so clients can process their experience and translate it into meaningful, lasting change.
Key Differences Between TMS and Ketamine Therapy
Even though both treatments target depression, they differ in some important ways:
- Mechanism – TMS stimulates specific brain regions through magnetic pulses, while ketamine works on a chemical level to promote neural growth and rewire mood-related pathways.
- Experience during treatment – TMS clients stay fully alert and can return to normal activities right after a session. Ketamine infusions produce a dissociative, sometimes dreamlike state during the session itself, which is why medical supervision matters so much.
- Speed of results – Ketamine often produces noticeable shifts within hours or days. TMS tends to build gradually over several weeks of consistent sessions.
- Session frequency and length – TMS typically requires 18 minute sessions with consistent visits over 6 to 9 weeks. Ketamine infusions involve fewer visits, often 6 sessions over 2 to 3 weeks for an initial series.
- FDA approval scope – TMS carries FDA clearance for depression and OCD. Ketamine remains largely an off-label treatment, aside from the FDA-approved esketamine nasal spray Spravato.
Neither treatment works better across the board. The right choice depends on your diagnosis, your history with other treatments, and honestly, your schedule and lifestyle.
Which Conditions Does Each Treatment Target?
TMS treatment has the strongest evidence base for major depressive disorder, particularly for clients who haven’t responded to at least two antidepressant medications. It also shows promise for OCD, and researchers continue to study its use for anxiety and PTSD.
Ketamine therapy tends to help with a broader range of conditions, including treatment-resistant depression, anxiety disorders, PTSD, and in some cases chronic pain. Ketamine has also shown particular promise for clients experiencing suicidal ideation, given how quickly it can shift mood in acute situations.
If your primary diagnosis is major depressive disorder and you haven’t yet explored insurance-covered options, TMS might make sense as your first step. If you’re dealing with more complex, treatment-resistant symptoms or need faster relief, ketamine may be worth exploring first. A psychiatric evaluation with our team will give you a much clearer answer than guessing on your own.
How Long Does Each Treatment Take?
This is often where the two treatments diverge the most in terms of lifestyle impact.
A full TMS course usually involves 30 to 36 sessions over 6 to 9 weeks. Each session runs about 20 minutes, and clients need to commit to a fairly demanding schedule for the full course to work.
Ketamine treatment, by comparison, involves far fewer visits. Most clients start with an induction series of about 6, one-hour sessions over 2 to 3 weeks, followed by occasional maintenance sessions spaced weeks or months apart. For clients juggling demanding jobs or family schedules in Manhattan, that difference in time commitment can matter a great deal.
Some clients prefer the steady, gradual nature of TMS, while others need the shorter, more concentrated commitment that ketamine offers.
Cost and Insurance Considerations in NYC
Cost and insurance coverage often become the deciding factor for many clients, so let’s break down the real numbers.
TMS therapy tends to work in your favor when it comes to insurance. Most major insurers cover TMS for major depressive disorder once you’ve documented at least two failed antidepressant trials.
Ketamine infusion therapy, on the other hand, usually falls outside standard insurance coverage since most formats remain off-label. Some clients successfully submit for partial reimbursement through out-of-network benefits or use HSA and FSA funds to help offset the cost.
The depression treatment NYC clients pursue often comes down to weighing upfront cost against insurance accessibility. TMS may cost less out of pocket if your insurer approves it, while ketamine may cost more initially but offer faster results and fewer required visits. Our team at Holme Wellness walks every patient through both scenarios so you can make a fully informed decision.
How to Choose the Right Treatment at Holme Wellness
The honest answer is that you don’t have to choose alone. At Holme Wellness, conveniently located in the Flatiron district, our psychiatric team evaluates your full history, your previous treatment attempts, your symptoms, and your lifestyle before recommending TMS, ketamine, or another path entirely.
Some clients even benefit from a combination approach over time, starting with one treatment and layering in the other based on how they respond. What matters most is that your treatment plan reflects your actual clinical picture rather than a one-size-fits-all protocol. Our NYC-based team takes the time to get this right, because we know how much is riding on finding a treatment that actually works for you.
Frequently Asked Questions
Is TMS or ketamine therapy more effective for depression?
Both treatments show strong evidence for treatment-resistant depression, but effectiveness varies by individual. TMS tends to work well for clients who haven’t responded to at least two antidepressant medications, while ketamine often helps clients who need faster relief or have more complex, treatment-resistant symptoms.
Does insurance cover TMS therapy in NYC?
Most major insurers cover TMS therapy for major depressive disorder once you’ve documented a history of failed antidepressant trials. Coverage varies by plan, so it’s worth confirming your specific benefits before starting treatment.
How many TMS sessions will I need?
A standard TMS course involves 30 to 36 sessions, administered five days a week over 6 to 9 weeks. Some clients need additional sessions depending on how they respond.
Can I switch from TMS to ketamine therapy if it doesn’t work?
Yes. Many clients try TMS first, especially if insurance covers it, and move to ketamine therapy if they don’t see the results they hoped for. Our team can help you transition between treatments based on your response.
Which treatment works faster, TMS or ketamine?
Ketamine typically produces noticeable results within hours or days, while TMS tends to build gradually over several weeks of consistent sessions.
Are there side effects with TMS or ketamine therapy?
TMS carries a mild side effect profile, with some clients experiencing scalp discomfort or mild headaches. Ketamine can cause temporary dissociation during the session itself, which is why medical supervision remains essential throughout treatment.
Can I do both TMS and ketamine therapy at the same time?
Some clients pursue both treatments as part of a broader psychiatric care plan, though this depends on your specific diagnosis and history. A consultation with our psychiatric team can help determine whether combining treatments makes sense for you.
Not sure whether TMS or ketamine therapy fits your needs? Contact Holme Wellness today to schedule a consultation with our NYC-based psychiatric team and get a personalized recommendation based on your history and goals.