The key lies in personalized treatment selection based on your unique symptom profile, previous treatment responses, and clinical factors.

Deep TMS: The Most Advanced Depression Treatment

Deep transcranial magnetic stimulation (Deep TMS) represents the breakthrough in depression treatment technology. This should not be confused with rTMS which was first generation TMS and reported a 40-50% efficacy rate and 35% remission rate.

This unique, noninvasive treatment process helps alleviate symptoms related to mental health conditions and is FDA-cleared to treat Major Depressive Disorder and Obsessive-Complusive Disorder.

How Deep TMS Works

Deep TMS uses patented H-Coil technology held inside a helmet apparatus fitted over the patient’s head. The electromagnetic field safely sends magnetic pulses that directly reach deeper, broader brain structures, successfully influencing their neural activity.

This advancement over standard figure-8 TMS treatment offers two critical advantages:

Direct Deep Brain Access: The ability to reach deeper brain structures directly prevents decrease in magnetic field intensity, maintaining effectiveness without increasing intensity to levels that risk undesirable side effects.

Broader Treatment Scope: The ability to avoid increased intensity allows Deep TMS to broaden the scope of its electromagnetic field, reaching more relevant brain regions while maintaining safe activation levels. The deeper, broader field enhances targeting of correct brain regions, eliminating the need for complex neuronavigation equipment.

Deep TMS Treatment Process

Session Duration: Each Deep TMS session takes approximately 30 minutes.

Treatment Schedule: Administered five times per week for the first 4 weeks. Continuation phase continues for two times per week for an additional 8 weeks.

No Downtime: Unlike other treatments, you can return to normal activities immediately after sessions.

Success Rates: Studies show success rates ranging from 82%, with over 65% achieving remission.

Insurance Coverage: Deep TMS is covered by insurance after documentation of failed antidepressant trials.

Accelerated Protocol: We are now offering an accelerated 6 day protocol which consists of 5 10 minute treatments as day for 6 days over 2 weeks. This is not covered by insurance and is only available through cash pay.

Who Benefits Most from Deep TMS

Deep TMS is particularly effective for individuals with treatment-resistant depression, burnout or who want peak cognitive performance enhancement. Because it increases neuroplasticity, enhances sleep, and focus, it’s beneficial and beyond just treating depression, but insurance will not cover it for off label use.

It’s also effective for pregnant women and others who prefer non-pharmacological approaches or experience significant side effects from medications.

Spravato: Rapid-Acting Depression Relief

Spravato (esketamine) represents a revolutionary breakthrough in depression treatment. Unlike traditional antidepressants that take weeks to work, Spravato provides relief within hours for many patients.

Understanding Spravato’s Unique Mechanism

Spravato works differently from traditional antidepressants. Instead of targeting serotonin or dopamine, it acts on NMDA receptors in the brain, triggering glutamate release the brain’s most abundant neurotransmitter. This rapid action promotes neuroplasticity, helping the brain form new connections and pathways.

Spravato Treatment Experience

https://youtu.be/Tw9mcXXp-G0?t=93

Administration: Self-administered nasal spray under clinical supervision in certified treatment centers.

Session Duration: Each session lasts approximately 2 hours with close monitoring.

Initial Schedule: Twice weekly in the first month, then weekly maintenance sessions.

Rapid Results: Many patients experience improvement after the first treatment, with clinical studies showing significant symptom reduction at week 4.

Success Rates: Approximately 65% report benefits, with 36% reaching remission.

FDA Approval and Safety

Spravato is FDA-approved for treatment-resistant depression and major depressive disorder with suicidal ideation. The treatment is administered only through certified centers participating in the FDA Risk Evaluation and Mitigation Strategy (REMS) program, ensuring maximum safety and proper oversight.

Insurance Coverage for Spravato

Most major insurance providers cover Spravato treatment. Many patients pay as little as a $20 copay with proper insurance coverage. For Medicaid patients, treatment is often provided at no cost through ‘Spravato with Me’ programs.

Spravato for ketamine-assisted pyschotherapy

Psychotherapy addresses the root causes of depression while building lasting coping skills. Research consistently demonstrates that therapy provides protection against relapse even after treatment completion.

While many people are paying out of pocket for lozenges, intramuscular injections, or IV ketamine, Spravato is covered by insurance and can be used for ketamine-assisted psychotherapy. Its main advantage is that it is covered by insurance, and we monitor patients while in treatment in-clinic, which makes it much safer. Patients have experienced hypoxia before and it’s important that rescue meds/oxygen is applied diligently when this occurs.

We’ve had many patients who have done psychotherapy with their therapist from the comfort of their private Spravato treatment room either in the second hour of treatment, or they can schedule at a time within 72 hours of treatment. Anecdotally, our patients have preferred to schedule with their therapists the day after treatment to give them time to process the emotions and feelings that came during Spravato treatment.

Ketamine therapy offers hope to patients for whom frontline mental health treatments like traditional therapy don’t work alone. This breakthrough treatment represents a powerful integration of advanced neuroscience with psychotherapeutic approaches.

Spravato vs Ketamine: Same Results

Spravato nasal spray contains esketamine, a refined extract of ketamine. Studies from Cambridge and Yale show that the effects of ketamine vs. esketamine are identical.

Treatment Protocol:

• First month: Two treatment sessions per week
• Second month: One session per week
• Maintenance phase: Treatments as required after 8 weeks
• Session duration: 2 hours with clinical supervision

Clinical Effectiveness: 50%-70% of patients experience significant improvement, often within 2-4 weeks.

Safety and Supervision

Professional ketamine treatment requires proper medical supervision due to temporary cognitive effects. Patients cannot drive after treatment due to potential cognitive impairment, dizziness, and dissociative effects. At-home ketamine therapy can be dangerous and far less effective, making clinic-based treatment essential for safety and optimal outcomes.

Treatment-Resistant Depression: Advanced Options

Approximately 30% of people diagnosed with major depressive disorder develop treatment-resistant depression, requiring specialized interventions beyond standard approaches.

Combination Treatment Strategies

The most effective approach for treatment-resistant depression involves combining multiple evidence-based treatments:

Deep TMS + Spravato: Both treatments promote neuroplasticity through different mechanisms. Deep TMS uses magnetic pulses to stimulate underactive brain regions, while Spravato enhances glutamate signaling and synaptic growth.

Ketamine-Assisted Therapy: Combining neuroplasticity enhancement with intensive therapeutic processing for comprehensive healing.

Do you want to know how much TMS will cost with your insurance coverage?

Book a free financial consultation with our expert Rachel!

At your appointment, we’ll tell you:

1. What your insurance plan requires to cover treatment
2. Your estimated out-of-pocket cost
3. If you qualify for financial assistance programs

We believe that costs should not be the only reason you don’t get the mental health care. Ask Rachel about payment plans, alternative payments, and more on your call.

Get Free Treatment Cost Consultation

Book Now Before Slots Fill-out.

How to Choose the Right Treatment for Your Situation

Severity-Based Treatment Selection

Mild to Moderate Depression:

• Individual therapy may be sufficient as a starting point
• Lifestyle modifications and self-care strategies
• Regular monitoring and assessment

Moderate to Severe Depression:

• Combination treatment approaches recommended
• Consider advanced treatments like Deep TMS or Spravato
• Comprehensive psychiatric evaluation

Severe or Treatment-Resistant Depression:

• Immediate advanced intervention required
• Combination of Deep TMS, Spravato, and intensive therapy
• Specialized psychiatric care with experienced providers

Individual Factors to Consider

Treatment History: Previous treatment responses help guide current decisions. Failed medication trials may indicate need for advanced treatments like Deep TMS.

Symptom Profile: Specific symptoms can guide treatment selection. Suicidal ideation may indicate need for rapid-acting treatments like Spravato.

Lifestyle Considerations: Work schedules, transportation access, and support systems influence treatment feasibility.

Insurance Coverage: Understanding your benefits helps determine most cost-effective treatment approaches.

Who Leads Care?

 

You never need a referral to see Axis Integrated Mental Health directly, however, since 79% of antidepressants in the United States are prescribed by primary care physicians, you are likely to start your mental health journey there. This chart explains who typically takes the lead in your care depending on how severe your depression symptoms are and how you’re responding to treatment.  For mild to moderate depression, your primary care provider (PCP) often leads care. They may start you on medications, lifestyle changes, or therapy referrals. If symptoms don’t improve after about six to eight weeks, it’s time to consider a higher level of care.

For moderate to severe depression or suicidal thoughts, care usually shifts to a psychiatric specialist team–like Axis Integrated Mental Health’s providers who can offer advanced treatments such as Transcranial Magnetic Stimulation (TMS) or Spravato® (esketamine). These treatments are covered by insurance and delivered under close psychiatric supervision. We can work with your primary care physician or another psychiatric provider to only deliver the intervention you need, or we can be your primary prescriber as well if that’s what you prefer. If there’s still no improvement after about twelve to sixteen weeks, or if suicidal thoughts intensify, care should be escalated again.

In cases of severe depression, substance use, or crisis, care transitions to specialty psychiatric centers or hospitals, where you have access to more intensive, daily treatment and 24/7 support. For individuals experiencing suicidality, crisis, or psychosis, an inpatient hospital team provides round-the-clock monitoring and crisis stabilization. In short, your care starts with your primary provider and escalates to specialized psychiatric care if symptoms persist or become critical–ensuring you always have the right level of support at the right time.

What to Expect: Timeline and Success Rates

Treatment Timeline Expectations

Deep TMS: 4-week acute phase with sessions 5 times per week. Many patients notice improvement within 2-3 weeks. Continuation phase is 2x per week for 8 more weeks.

Phase / timepoint	Expectation of efficacy / onset	Remission / response benchmarks	Notes & caveats
First ~2 weeks of treatment	Some early signal of improvement may appear (mood, energy) but often subtle	—	In practice, patients often begin noticing changes after 1 to 2 weeks of treatment. (PrairieCare)
By 14 sessions (mid-course)	Many patients reach a response threshold	Median onset of response has been reported around the 14th session in some studies. (PMC)
By 20 sessions	Higher fraction of patients in response / some remission	In a late-life depression study: ~70 % response by 20 sessions; remission ~40 %. (PMC)
By 30 sessions (end of typical acute course)	Peak response and remission in many patients	Response ~80 %; remission ~60 % (or higher depending on scale) in some reports. (PMC)
Maintenance / durability	Risk of relapse begins over months	Some evidence of sustained effects for 3 months, with biweekly “maintenance TMS” helping durability. (PMC)

 

Spravato: 8 week induction phase. Twice a week in Month 1 and 1x a week in month 2.

Phase / timepoint	Expectation of efficacy / onset	Remission / response benchmarks	Notes & caveats
Within 24 hours	Many patients show a rapid antidepressant effect	Some trials show early reductions in depressive symptoms as fast as 24 hours after first dose. (PMC)
By week 4 (end of induction)	Stronger response / remission signals	In TRD trial, ~52.5% receiving Spravato + antidepressant had remission vs ~31.0% in control arm by Week 4. (Spravato)
Weeks 4–24 (optimization / maintenance phase)	Sustained benefit, some incremental gains	Over 24 weeks, some patients maintain or improve response/remission. Remission by PHQ-9 ~28.1% at 24 weeks. (PMC)
Longer term (up to 1 year)	Maintenance of effect in many patients	In long-term follow-up, many benefits are maintained; remission rates (e.g. MADRS) ~40–47% in some long-term studies. (OUP Academic)

Interpretation / caveats

• Esketamine is distinct for its fast onset relative to conventional antidepressants, often showing measurable improvement within hours to days.
• The dosing schedule (twice weekly in induction, then less frequent) is designed to consolidate response.
• Some decline or relapse can occur, so continuation or maintenance dosing is critical.
• Response/remission rates vary by trial and by whether it’s used adjunctively or as monotherapy

IV Ketamine: 4-6 infusions given over 2-3 week timeframe.

Phase / timepoint	Expectation of efficacy / onset	Remission / response benchmarks	Notes & caveats
Within hours to 1 day	Rapid symptom relief / early efficacy	Many patients experience meaningful improvement (≥ 50% symptom reduction) within hours. (PMC)
After serial infusions over ~1–2 weeks	Increased response / remission over repeated dosing	In a series of 6 infusions, >50 % response and ~20–25% remission have been found. (Psychiatry Online)
By ~2–4 weeks after last infusion	Many patients sustain improvement	Some studies show response ~54–55%, remission ~30–40% at 3–4 weeks after infusion series. (PMC)
Longer term / maintenance	Effects often wane (relapse without further treatment)	Ketamine’s antidepressant effects are often transient (days to weeks), requiring repeated infusions or adjunctive strategies to sustain response. (SpringerLink)
In extended series or maintenance regimens	Some patients maintain remission over months	In a long-term repeated infusion study, response and remission rates reached ~80.3% / ~78.9% at 9 months among those who continued meeting response criteria. (PubMed)

Interpretation / caveats

• Ketamine is among the fastest-acting antidepressant-type treatments, but its durability is one of its key challenges.
• Sustaining remission usually requires ongoing or maintenance dosing, augmentation, or additional therapies.
• Because many studies are open-label or small, exact timelines are less well-established than for antidepressants or Esketamine.

Conventional Antidepressants

Phase / timepoint	Expectation of efficacy / onset	Remission / response benchmarks	Notes & caveats
Week 1	Some early signal (≤ 20–30% improvement) in a subset	Early improvement (≥ 20% symptom reduction) in weeks 2–4 is predictive of later remission. (PMC)
Weeks 2–4	Improvement becomes clearer in many patients	Meta-analyses often show separation from placebo by week 2–4. (PMC)
Weeks 6–8	Many patients achieve response (≥ 50% symptom reduction)	In multiple trials, a substantial proportion respond by this timeframe. (PMC)
By week 12 (3 months)	Maximal acute benefits (for first antidepressant)	Remission rates in well-conducted trials often occur between 8–12 weeks. (Cleveland Clinic Journal of Medicine)
Beyond 12 weeks / continuation	Further gains are possible, but diminishing returns	Some patients continue improving with longer treatment or augmentation strategies. (PMC)
Maintenance / relapse prevention	Many patients need continued therapy for 6–12 months or longer	Discontinuation too early often leads to relapse; many guidelines recommend maintenance for at least 6 months after remission. (Nature)

 

• Conventional antidepressants are slower in onset compared to ketamine or Esketamine, but they have more sustained durability and a larger evidence base for long-term use.
• Early improvement (within 2–4 weeks) is a helpful prognostic sign: patients without early improvement are less likely to remit. Lippincott+3PMC+3PMC+3
• Because many trials are limited to 8–12 weeks, estimates beyond that are less precise. medRxiv

Insurance Coverage and Treatment Access

Understanding Coverage for Advanced Treatments

Deep TMS Coverage: Covered by most insurance plans after documenting failed antidepressant trials. Full treatment courses typically cost $12,000-$15,000 but are covered after 2 failed med trials. Not covered by Medicaid in Colorado.

Spravato Coverage: Covered by most major insurance providers, including Medicaid. Many patients pay $20 copays or less with proper coverage.

IV Ketamine: Typically $450-$650 per infusion. Cash pay only. Not covered by insurance.

Therapy Coverage: Mental health parity laws ensure therapy coverage equivalent to medical treatments.

Making Treatment Affordable

Insurance Verification: We will help verify benefits, manage all prior authorizations, and determine out-of-pocket costs.

Payment Plans: We do offer structured payment options for uncovered services.

Transportation Support: We provide transportation assistance to ensure treatment continuity in the form of a one-time $90 uber voucher at the start of treatment..

Additional Resources

The best treatment for depression depends on your unique situation, symptoms, and treatment history. Advanced treatments like Deep TMS and Spravato represent significant breakthroughs for individuals who haven’t found success with traditional approaches.

Deep TMS offers the most advanced brain stimulation technology, directly targeting deeper brain structures involved in mood regulation. Spravato provides rapid relief through its unique glutamate-based mechanism. When combined with evidence-based therapy, these treatments create comprehensive approaches to depression recovery.

Treatment-resistant depression is not untreatable depression. With proper evaluation and access to advanced treatments, most individuals can achieve significant symptom improvement and sustained recovery.

The key is working with experienced providers who understand how to coordinate these treatments effectively. Integrated care approaches that combine psychiatric expertise, advanced treatments, and therapeutic support offer the best outcomes for lasting recovery.

Remember that seeking help is a sign of strength, not weakness. Depression is a medical condition that responds to proper treatment. With today’s advanced options, there are more reasons for hope than ever before.

Frequently Asked Questions

How long does it take for depression treatment to actually work?

The timeline varies significantly by treatment type. IV Ketamine provides the fastest response rate but typically, results don’t last and it’s not covered by insurance. Spravato often provides relief within hours, with many patients experiencing improvement after the first session. Deep TMS typically shows benefits within 2-3 weeks of starting the 6-week treatment course. Traditional therapy may take 4-6 sessions to show initial benefits, with significant improvement over 12-20 sessions.

Can you combine treatments like Spravato and Deep TMS?

Yes, Deep TMS and Spravato can safely be combined. For many patients with treatment-resistant depression, this approach can be more effective than either treatment alone. Both therapies target the brain differently: Deep TMS uses magnetic pulses to stimulate specific neural networks involved in mood regulation, while Spravato (esketamine) works on the glutamate system to rapidly increase neuroplasticity and relieve depressive symptoms. When used together under psychiatric supervision, they can complement each other by improving both short-term symptom relief and long-term brain healing. At Axis Integrated Mental Health, our psychiatric team often coordinates these treatments as part of a personalized care plan to maximize response and help patients achieve faster, more durable remission.

Is it worth trying advanced treatments if traditional approaches didn’t work?

Absolutely. Advanced treatments like Deep TMS and Spravato work through entirely different mechanisms than traditional approaches. Treatment-resistant depression specifically indicates need for innovative interventions. These treatments target different brain systems and can be effective even when traditional approaches have failed.

How much does advanced depression treatment cost and what does insurance cover?

Most insurance plans cover evidence-based depression treatments. Deep TMS is covered after documenting 2 failed medication trials, with full courses typically covered when medically necessary. Spravato is covered by most major insurance providers, with many patients paying $10 copays or less. Treatment centers help verify benefits and determine exact costs.

How long does it take to start an advanced depression treatment like Deep TMS or Spravato?

At Axis Integrated Mental Health, we have zero waitlists for appointments with a psychiatric provider to begin the process. Approval timelines can vary depending on your insurance provider, medical history, and the type of advanced treatment you’re pursuing. At Axis Integrated Mental Health, most patients receive approval for Deep TMS or Spravato within 5–10 business days once all required documentation is submitted. This includes a psychiatric evaluation, medical records, and proof of prior antidepressant trials (which most insurance companies require for coverage). Our care team handles the entire pre-authorization process, from submitting paperwork to communicating with your insurer. For patients paying out-of-pocket or using special programs, treatment can often begin within a week of the initial consultation.