Frequently Asked Questions

While no mental health disorder has a permanent cure, TMS offers potential for lasting mental health improvements, and has provided relief for many individuals struggling with depression. Research indicates that 83% of patients experience at least a 50% reduction in depressive symptoms after treatment, with 62% achieving remission and nearly complete relief. In one study, 62.5% of those who saw improvement continued to see positive results or remained in remission a year later. 

No. TMS operates differently from electroconvulsive therapy (ECT). TMS specifically targets areas of the brain associated with depression through magnetic pulses, whereas ECT induces a seizure across the entire brain. The treatment processes also differ significantly. TMS is non-sedating and can be performed in outpatient settings, like a Greenbrook office, allowing you to drive yourself home afterward without any recovery time. In contrast, ECT requires anesthesia and must be administered in a hospital, meaning you'll need someone to drive you home after the procedure. 

Traditional antidepressants are believed to work by boosting serotonin and other neurotransmitters, which then influence glutamate—a brain chemical that helps regulate mood and depression. Spravato® uses esketamine, and is thought to directly target the glutamate system, activating receptors that promote the formation of new pathways in the brain. Although Spravato® is FDA-approved for treatment-resistant depression and for alleviating depressive symptoms in adults with major depressive disorder who experience suicidal thoughts or actions, researchers are actively studying its full impact. 

Ketamine has been utilized as an anesthetic and pain reliever since the mid-20th century, and may be known as a drug that is abused for its hallucinogenic and anesthetic properties. Spravato® is an esketamine nasal spray, a derivative of ketamine, and is FDA-approved for treatment-resistant depression and for alleviating depressive symptoms in adults with major depressive disorder who experience suicidal thoughts or actions. Most major insurance plans cover Spravato®. In contrast, ketamine is frequently used off-label to treat depression, but it has not received FDA approval for this purpose and is typically not covered by insurance. Select Greenbrook locations offer Spravato® treatment, but none of our locations offer IV ketamine treatments. 

Most major insurance plans cover both TMS therapy and Spravato®. For Spravato®, insurance will usually cover the treatment if you haven’t gotten better after trying two oral antidepressants. Greenbrook also accepts Medicare and Medicaid at various center locations. You can schedule a free consultation to get more information about what your insurance provider will cover for your treatment.

You don’t need to be on medication to undergo TMS therapy; it can be done alongside your current medications or without any. However, to receive Spravato® therapy, you must be taking an antidepressant medication. Our Greenbrook Care Team can work with you and/or your current healthcare provider to discuss what the best treatment plan is for you. 

TMS therapy and Spravato® are options for patients struggling with depression. Many of our patients have previously tried treatments like talk therapy or antidepressant medication without finding relief, or experiencing difficult-to-manage side effects. There’s no "typical" patient—if you’re suffering or suspect you might have depression, it’s crucial to seek care. We’re here to help, and there’s a good chance we can provide the support you need. Call us to discuss if TMS or Spravato® treatments are right for you. If you are experiencing suicidal thoughts or ideations and need help right away, call or text 988 or go to your nearest emergency room.  

TMS is fundamentally different from medications and talk therapy, operating through a unique mechanism of action. While medications affect the entire body as they cross the blood-brain barrier, TMS specifically targets the brain areas associated with depression and mood regulation. Because TMS is not a medication, you won’t experience common drug-related side effects like gastrointestinal problems, trouble sleeping, or weight gain. 

Most patients experience a gentle tapping sensation during TMS treatment, typically felt under the electromagnetic coil on the scalp. This sensation arises from the magnetic field stimulating the muscles and nerves in the brain. Most people find the treatment quite comfortable. That's why we encourage you to use your phone, watch TV, chat with our technicians, or read a book while you’re receiving treatment. 

Many people begin to notice improvements from TMS treatment within 3 to 4 weeks. While everyone’s experience is unique, this timeframe is when most individuals start to see results. Early on, those responding to treatment often report physical changes, such as increased energy or improved sleep. Friends, family, and coworkers may also notice a positive shift in their behavior. Around the three-and-a-half to four-week mark, individuals commonly feel less depressed, more motivated, and more engaged in activities, leading to less isolation. We strongly encourage completing the full course of TMS therapy, even if you start feeling better, to achieve the maximum benefits. 

No, you cannot do Spravato® at home or on your own. It must be given at a certified Risk Evaluation and Mitigation Strategy (REMS) center, like our convenient Greenbrook centers. Spravato® is not available for purchase at pharmacies. The trained medical staff at our certified treatment centers are equipped to prescribe, dispense, and administer Spravato®, following established protocols in accordance with the REMS program.  

A typical round of esketamine nasal spray treatment is broken up into three phases: 

• Induction, Week 1-4: 2 treatments a week 
• Maintenance, Week 5-8: 1 treatment a week
• Maintenance, Week 9+: 1 treatment every 1-2 weeks

Treatment plan varies by individual. Some patients complete maintenance after the initial induction plan.

As Dr. Geoffrey Grammer, our Chief Medical Officer, likes to say, “We’ll leave the porch light on.” Once you’ve finished treatment with us, we encourage you to check in with yourself and with your medical provider to keep an eye on your mental health. If you do need another round of TMS therapy or Spravato®, we’re here to help. Complete a Patient Health Questionnaire to gauge how you are feeling or call us directly to discuss your options. 

If someone has experienced significant benefits from TMS therapy, it’s entirely possible to reduce or even discontinue medications. The decision to stop medication is highly personal and should be discussed with your healthcare providers. Your TMS provider will collaborate with your primary care provider to determine the best approach for you, and your input will be an essential factor in how you proceed with or without medication.