Which New Depression Treatment Is Right for You? Compare Ketamine, Spravato, TMS & Psilocybin
A Comprehensive Guide to Understanding Modern Mental Health Treatments
Choosing the right treatment for depression can be overwhelming. From chat forums filled with conflicting opinions to confusing insurance rules, it’s hard to know where to start. At Axis Integrated Mental Health, we believe in empowering patients with clear, trustworthy information. This guide compares four modern treatment options we offer or discuss frequently in our Colorado clinics: Ketamine, Spravato, Deep TMS, and Psilocybin. Learn about their effectiveness, time commitment, cost, insurance coverage, and pros and cons. Please note, while we discuss these treatments, we only offer Spravato and Deep TMS at Axis Integrated Mental Health.
What Are the Most Promising New Treatments for Depression?
- Ketamine: A fast-acting, off-label treatment typically administered via IV or IM. Offers relief in hours for some patients.
- Spravato (Esketamine): An FDA-approved nasal spray used alongside an oral antidepressant. Covered by most insurances.
- Deep TMS (Transcranial Magnetic Stimulation): A non-invasive, FDA-approved therapy that uses magnetic pulses to stimulate areas of the brain involved in mood regulation.
- Psilocybin: A psychedelic compound being studied in clinical trials. Shows promise, but is not yet FDA-approved or legally available outside research settings.
How Do These Treatments Work?
- Ketamine and Spravato both act on NMDA glutamate receptors and increase BDNF and mTOR activity, promoting brain plasticity.
- TMS uses magnetic fields to regulate neural activity in mood-related brain circuits.
- Psilocybin binds to serotonin receptors, inducing altered states that may lead to therapeutic breakthroughs.
How Fast Do These Treatments Work?
Ketamine: Total treatment usually lasts 4 weeks or less. Each session takes 2–3 hours. Frequency depends on the diagnosis. Note: No driving after treatment, and patients may feel tired.
Spravato: Can continue long-term. Each session is 2 hours. Administered twice weekly in the first month, then weekly. No driving after sessions.
TMS: The Plan lasts 6 weeks. Each session takes about 30 minutes. Administered five times a week. No downtime required.
Psilocybin: Currently used in clinical trials. Sessions last 6–8 hours and are administered one or two times. Availability is highly limited.
What Does Each Treatment Cost?
Ketamine: $300–$800 per session. Not covered by insurance. Read more about Ketamine infusion cost here.
Spravato: $10 per session with commercial insurance and a rebate card. Read more about Spravato cost here.
TMS: $12,000–$15,000 for a full course if cash pay, although discounts offered if paying by cash. Please call to discuss. Covered by insurance after two failed antidepressant trials.
Psilocybin: Costs vary and are not covered by insurance. Only available in clinical or underground settings.
For a personalized insurance benefit check, call (720) 400-7025.
How Effective Are These Treatments?
Ketamine: About 55% of patients report improvement.
Spravato: Around 65% report benefits, with 36% reaching remission.
TMS: Success rates range from 50% to 60%, with about one-third reaching remission.
Psilocybin: Early trials suggest sustained symptom relief in some patients for up to a year, but research is ongoing.
Pros and Cons of Each Treatment
KETAMINE
Pros: Fast-acting, flexible dosing, strong PTSD results, no withdrawal, short treatment duration.
Cons: No insurance coverage, post-treatment downtime, maintenance required.
SPRAVATO
Pros: Covered by insurance, non-invasive, supervised, no needles, no withdrawal.
Cons: Requires concurrent antidepressant use, delayed relief, requires maintenance and downtime.
TMS
Pros: Non-pharmacological, minimal side effects, insurance-covered, no downtime.
Cons: 6-week time commitment, mild headache possible, clinical setting required.
PSILOCYBIN
Pros: Single-dose potential, long-lasting effects, generally non-addictive.
Cons: Not FDA-approved, variable dosing and sources, potential for psychosis, no medical oversight.
Matching Treatment to Your Needs
Not all treatments are equally suited for everyone. Consider:
- Time Off Work: TMS or psilocybin may require less recovery than ketamine or Spravato.
- Medication Sensitivity: TMS is ideal if you want to avoid pharmaceuticals.
- Insurance: Spravato and TMS are typically covered; ketamine and psilocybin are not.
- Symptom Severity: Ketamine may be preferred for acute cases or PTSD.
Talking to Your Psychiatrist
If you’re considering these options, here are a few questions to ask your provider:
- Do I meet the criteria for Spravato or TMS insurance coverage?
- What are the side effects or lifestyle considerations for each treatment?
- How quickly should I expect results?
- What happens if one treatment doesn’t work?
Ready to Take the Next Step?
Axis Integrated Mental Health offers personalized consultations to help you choose the best path forward. Call us at (720) 400-7025 or book an appointment online to start your journey toward better mental health.
Frequently Asked Questions
What are the main differences between ketamine and Spravato?
Ketamine and Spravato are closely related, but they are not the same treatment. Ketamine is an anesthetic that has been used off-label for depression, often through IV infusions. Spravato is the brand name for esketamine, a nasal spray version of one part of the ketamine molecule that is FDA-approved for treatment-resistant depression.
The biggest differences come down to access, insurance, and safety. Spravato is given in a certified clinic, requires medical monitoring, and is covered by many insurance plans. IV ketamine is usually not FDA-approved for depression and is often paid out of pocket. We break this down in more detail in our ketamine vs. Spravato guide.
Will my insurance cover TMS if I’ve tried antidepressants?
It might. Most major insurance plans cover Deep TMS for treatment-resistant depression when you have tried at least two antidepressants without enough relief. Some plans may also ask for documentation of therapy, your diagnosis, or prior authorization before treatment begins. At Axis, our team helps with the insurance steps so you are not stuck trying to figure it out alone.
For a fast estimate, use our TMS Cost Calculator. It gives you a general idea of what Deep TMS may cost with your plan, based on details like your deductible, copay or coinsurance, and out-of-pocket maximum. Your final cost depends on your specific benefits, and we verify coverage before treatment starts.
Is psilocybin legal or available in Colorado for depression?
Yes, but it is important to understand what that means. In Colorado, adults 21 and older may legally use certain natural medicines for personal use, and regulated psilocybin services are available through licensed healing centers or licensed facilitators. It is not like walking into a dispensary. Buying or selling psilocybin mushrooms or psilocybin products is still illegal.
Psilocybin is also not currently an FDA-approved medication for depression. It is being studied for treatment-resistant depression and major depressive disorder, and the research is moving forward, but it is still considered investigational at the federal level.
How soon will I start feeling better with these treatments?
Everyone’s timeline is different, but we know how hard it is to wait when you have already tried so many things. Spravato and ketamine-based treatments can work faster than traditional antidepressants for some people, though response is usually tracked over the first several weeks. Spravato treatment typically starts with a more frequent induction phase before moving into maintenance.
Deep TMS is usually more gradual. Many patients begin noticing improvement around weeks 3–4, and some people continue to feel gains even after the full treatment course is complete. With psilocybin, some people describe meaningful changes quickly, but lasting benefit depends heavily on preparation, support during the session, and integration afterward. Clinical data is still lacking.
What should I expect during my first Spravato or TMS session?
Your first session is designed to help you feel safe, informed, and supported. For Spravato, you will take the nasal spray in the clinic under medical supervision. Your care team will review what to expect, check your vitals, and monitor you for at least two hours afterward. Because Spravato can affect alertness, you will need a ride home and should not drive until the next day after a restful sleep.
For TMS, your first visit usually includes a consultation, treatment history review, and brain mapping. After that, treatment sessions are typically about 20 minutes. You stay awake, sit comfortably, and can return to normal activities afterward, including driving.
Want to feel more prepared before your first visit? Go to our New Patient Center to hear from real patients and get practical tips on how to prepare for Spravato and TMS.
