Many people ask me, "Should I try ketamine or should I try TMS?"
I am biased on this question, as a TMS provider. However, there are good reasons why I decided to become a TMS provider and why I have not yet chosen to start offering ketamine treatments in my office.
In my medical opinion based on research, ketamine is a quick temporary fix and TMS is a slow investment that makes lasting change over time. Obviously a quick fix is very appealing, especially when you are feeling awful. But ketamine's effects only last about a week, and require retreatment every time they go away-- which is not particularly healthy in the long term (can develop toxicity, addiction and a lot of expense).
There is also the fact that insurance covers TMS and not ketamine infusions. To me this is a major vote of confidence and safety. As annoying as insurance can be, they do quite a lot of due diligence on a treatment before they are willing to add it to their coverage policy. (In fact you can read all of their research if you look up your insurance plan’s TMS policy.)
TMS takes a while (36 sessions total, and it is common to not start feeling it until about #25), but lasts at least a year. And rather than putting a new substance into the body, it truly is increasing neuroplasticity and helping the brain to rewire itself, which is why there are virtually no side effects.
I'm always following the literature, and I think we'll get to a point where ketamine is a more useful tool. They're trying to find ways to "lock-in" the ketamine effect -- with a medication, maybe even with TMS. We're not there yet. An intranasal ketamine was FDA approved and is sometimes covered (Spravato). It has similar issues with non-longevity but at least it is safer to use repeatedly. Unfortunately the patient has to self-administer this treatment in a doctor's office and be observed for 2 hours to monitor for dissociation or blood pressure issues, a few times a week. I might eventually start offering that, but right now my impression is that the insurance headaches far outweigh any actual benefits.
If you might be interested in TMS, feel free contact me for a consultation, no charge – this is such foreign concept that I understand it needs to be talked through a lot first with someone familiar, before making any decision! Check out the testimonials on my TMS page as well as some FAQ videos.