Pros & Cons: TMS, Ketamine, Meds, Psychotherapy, Spravato

Quick takeaway Yes - TMS can be an effective option for some people with obsessive–compulsive disorder (OCD). In particular, deep TMS (dTMS) has received FDA clearance for OCD and is provided using specific, evidence-based protocols. At Elevium, TMS for OCD is offered as part of an integrated care plan that pairs neuromodulation with therapy, medication management, and careful clinical oversight. How TMS treats OCD - the basic idea TMS uses focused magnetic fields to change activity in brain circuits involved in mood and compulsive thinking. For OCD, clinicians target the networks thought to underlie obsessive thoughts and repetitive behaviors. Deep TMS (dTMS) uses a specialized coil to reach deeper brain structures implicated in OCD and is the modality that has been FDA-cleared for this indication. Clinical protocols are standardized so clinicians can safely and reliably deliver therapeutic stimulation. FDA approvals & what they mean The FDA has cleared specific dTMS systems for the treatment of OCD , which means there is a regulatory basis and controlled clinical evidence supporting its safety and effectiveness for eligible patients. FDA clearance also helps establish standardized treatment protocols and safety monitoring that clinics follow. Typical protocols & what a course looks like Intake & screening: A full psychiatric and medical evaluation is performed to confirm the OCD diagnosis, review prior treatments (therapies and medications), and screen for contraindications (for example, certain implants or seizure risk). Treatment schedule: OCD TMS protocols are typically delivered as a course of daily sessions over multiple weeks. The length of each session and the total number of visits depend on the specific dTMS protocol used and the patient’s clinical response. Monitoring & follow-up: Symptoms are tracked with standardized scales; clinicians adjust the plan and recommend complementary therapies (e.g., ERP — exposure and response prevention) as needed. Elevium’s guidance emphasizes standardized protocols and close outcome tracking to optimize results. Success rates & evidence (what research and clinic experience show) Clinical trials and real-world clinic reports show that many patients with OCD experience meaningful symptom reductions after a full course of dTMS, and some achieve remission. Outcomes vary by individual factors (severity, duration of illness, prior treatment response). Elevium’s TMS for OCD materials summarize published evidence and emphasize honest, individualized expectations during the consent process.

Quick overview When evidence-based talk therapy and medication management don’t bring sufficient relief, Elevium offers advanced, clinically proven options that can help many people regain function and hope: TMS (Transcranial Magnetic Stimulation) — a non-invasive, FDA-cleared brain-stimulation therapy for depression and certain other conditions. Spravato (esketamine) — an FDA-approved, rapidly acting medication for treatment-resistant depression given in-clinic under a REMS safety program. Ketamine (IV/IM/compounded intranasal/oral) — an off-label but increasingly used rapid-acting option with a different regulatory and coverage profile than Spravato. Each has different mechanisms, logistics, evidence levels, and cost/coverage patterns. Below, we explain how they work, who they help, what to expect, and how Elevium integrates them into personalized care. First step: careful re-evaluation Before recommending an advanced therapy, Elevium begins with a comprehensive reassessment: review of diagnosis, co-occurring conditions ( anxiety, PTSD, bipolar spectrum, substance use ), medication history, prior psychotherapy responses, safety (including suicidal risk), medical history, and relevant labs or imaging. This ensures that the chosen option is medically appropriate and that reversible contributors (such as sleep, thyroid, substance, and medication interactions) have been addressed. Elevium’s medication-management and intake workflows emphasize this structured evaluation and shared decision-making. TMS: how it helps when meds/therapy aren’t enough How it works TMS uses focused magnetic pulses to stimulate brain regions involved in mood regulation (commonly the left dorsolateral prefrontal cortex). It is a non-invasive procedure performed while the patient is awake. Evidence shows TMS can significantly reduce depressive symptoms in many patients who have not responded to multiple medication trials. Who it’s for People with treatment-resistant depression (failed adequate trials of antidepressants) or those who can’t tolerate medication side effects. Selected patients with OCD or other indications, when supported by the device/protocol and clinical judgment. (Device-specific approvals and local practice guide candidacy.) What the course looks like Intake & screening: psychiatric evaluation, medical history, and motor-threshold titration. Typical course: daily sessions (usually 5×/week) for ~4–6 weeks (about 20–30 sessions). Some accelerated protocols (e.g., iTBS) use much shorter sessions. During sessions, patients are awake, can read or relax, and usually resume normal activities afterward. Side effects are most commonly scalp discomfort or headache; seizures are rare with proper screening. Why does it help when meds fail TMS offers a non-systemic approach that targets neural circuits directly rather than changing neurotransmitter levels systemically. That means patients who did not respond to medication trials sometimes respond to TMS. Pros/cons summary Pros: FDA-cleared, few systemic side effects, durable responses for many. Cons: Time commitment (daily visits), potential for scalp pain/headache, insurance often requires prior authorization and documentation of prior treatment failures.

What is TMS (Transcranial Magnetic Stimulation)? TMS uses focused magnetic pulses to stimulate targeted areas of the brain (most commonly the left dorsolateral prefrontal cortex for depression). Pulses are delivered with a coil placed on the scalp; treatment is done while awake and does not require anesthesia. Variants: Standard rTMS: sessions ~30–45 minutes. iTBS (intermittent theta burst stimulation): accelerated protocol with much shorter sessions (often 3–10 minutes) that can produce similar clinical results in many patients. Safety & Side Effects: The most common side effects are mild scalp discomfort or headache, which typically resolve. Serious events (seizures) are rare when patients are properly screened and protocols followed. Who is a candidate for TMS? TMS is typically considered when: A patient has major depressive disorder that has not responded adequately to multiple antidepressant trials or therapy. Medication side effects are intolerable, or the patient prefers a non-drug option. The patient can attend frequent sessions and has no contraindications (e.g., certain metal implants near the head, unshielded intracranial hardware, or an active condition that raises seizure risk). For teens: certain devices have adolescent indications — candidacy is determined by device labeling and clinician judgment. Typical pre-treatment evaluation includes: psychiatric assessment, medical history, medication review, seizure risk evaluation, and review for metal implants. A baseline symptom scale (PHQ-9, etc.) is often used to track progress. What to expect during treatment (timeline & session flow) Evaluation & prep Initial consult / intake (60–90 minutes): psychiatric history, prior treatments, informed consent, and screening. Motor threshold titration: first appointments set the stimulation intensity based on each patient’s motor threshold (a quick calibration). Treatment course Frequency: Most standard protocols are 5 sessions per week (Mon–Fri). Duration: Typical acute course is 4–6 weeks (totaling ~20–30 sessions). Some protocols extend to 6 weeks or include additional sessions for partial responders. Session length: Traditional rTMS sessions 20–45 minutes; iTBS sessions about 3–10 minutes. Maintenance: Some patients have periodic maintenance TMS (weekly or monthly) if symptoms recur. During a session You’ll sit comfortably. The technician positions the coil and runs the protocol. You’re awake and alert and can read, use your phone, or relax. Most patients return to normal activities immediately after (unlike treatments that require post-procedure monitoring or sedation).

Quick overview Medication management at Elevium is a collaborative, medical approach to treating mood, anxiety, and related conditions. It’s not just “getting a prescription” - it’s an ongoing process of assessment, careful medication selection, safety monitoring, and coordination with therapy and other supports. Elevium’s medication management workflow is designed to be evidence-informed, patient-centered, and transparent about costs and logistics.

Quick answer If you’re a parent looking at TMS (transcranial magnetic stimulation) or Spravato (esketamine nasal spray) for a teen with depression, the biggest takeaway is this: TMS has FDA-cleared options for some adolescents (ages 15–21) as an adjunct treatment for major depressive disorder, depending on the specific TMS system and clinical scenario. Spravato is not established for pediatric patients (safety/effectiveness in people under 18 hasn’t been established in labeling). Spravato also requires in-clinic administration and at least 2 hours of monitoring each session due to risks like sedation/dissociation and respiratory depression. Below is a parent-friendly guide: eligibility, safety data, FAQs, and what options a clinic like Elevium may offer for younger patients. What are these treatments? TMS (Transcranial Magnetic Stimulation) TMS uses a magnetic coil placed on the scalp to stimulate brain circuits involved in mood regulation. It’s non-invasive, done awake, and doesn’t require anesthesia. In youth research, the most common side effects are typically headache and scalp discomfort, and serious adverse events are uncommon when safety guidelines are followed. Spravato (Esketamine) Spravato is a controlled substance nasal spray administered under supervision in a certified healthcare setting with monitoring because of risks like sedation/dissociation and respiratory depression. It is not dispensed for home use. Spravato. For pediatric use, labeling states that the safety/effectiveness has not been established. Eligibility: Who might be a candidate? TMS eligibility (typical teen considerations) A teen may be considered when: Depression is moderate to severe and significantly impairing. Symptoms haven’t improved enough with evidence-based first-line care (therapy and/or medication), or there’s a reason meds aren’t a good fit. The teen can attend frequent sessions and cooperate with treatment. No contraindications (for example, certain metal implants near the head). Important age note: Some TMS devices now have FDA-cleared indications for adolescents 15–21 as adjunct treatment for MDD. Spravato eligibility for teens In practice, most reputable programs treat Spravato as an adult-focused option because pediatric safety/effectiveness is not established in the labeling. If a clinic considers ketamine/esketamine-type therapies for youth at all, it’s usually in highly specialized contexts with careful risk/benefit review and parent/guardian involvement.

Quick answer  Spravato (esketamine) - more likely to be covered by insurance for treatment-resistant depression or certain labeled indications because it is FDA-approved for those uses and provided under a REMS (safety) program. Coverage usually requires prior authorization and is commonly billed through the medical benefit (clinic/office administration), though specifics vary by insurer. Ketamine (racemic or other formulations) given for depression (IV, IM, oral, compounded intranasal) is generally off-label for psychiatric indications. Most commercial and government payers treat ketamine for depression as experimental/ investigational and do not routinely cover it, so patients commonly pay out-of-pocket. Exceptions can occur on a case-by-case basis. Below is a patient-friendly but practical breakdown to help you understand the differences, benefits, and when each option might be preferred. How insurers think about these two treatments 1. FDA approval & labeling (big insurer signal) Spravato (esketamine): FDA-approved specifically for treatment-resistant depression (and for depressive symptoms in certain cases). Because it’s approved and regulated (REMS), payers have a clear precedent for coverage policies — though they still typically require documentation of prior treatment attempts and a prior authorization. Ketamine (IV/IM/oral/compounded intranasal): Ketamine as an anesthetic is FDA-approved, but not specifically approved for depression except for esketamine. Using ketamine for depression is off-label, so most insurers label it “investigational” and don’t cover it routinely. 2. Delivery setting & billing pathway Spravato: Administered in a certified clinic with monitoring (because of REMS). Charges are generally billed under the medical benefit (clinic visit/drug administration/observation). In some systems, parts may route through the pharmacy/medical split — check your plan. Ketamine: Often given via IV infusion in outpatient infusion clinics/medical offices. Since this use is off-label, some insurers will not cover the drug or the infusion visit; even when they do, coverage is inconsistent. Ketamine given for anesthesia (unrelated uses) is covered in its approved context, but that does not imply coverage for depression treatment. 3. Evidence & guidelines Spravato has randomized trials, an FDA label, and published REMS safety requirements — this strengthens the case for insurer coverage. Ketamine has growing evidence showing rapid antidepressant effects but lacks a universal regulatory approval for depression (outside esketamine), so guidelines and payer policies are uneven. Benefits of each treatment (clinical perspective) Spravato (esketamine) Standardized, FDA-approved formulation and dose. REMS program requires safe administration and monitoring, which some insurers view positively. Good evidence for treatment-resistant depression and a clear pathway for prior authorization. Administered under supervision with structured follow-up — easier to document for insurers. Ketamine (IV/IM/oral/compounded) Flexible routes of administration (IV, IM, oral, intranasal) — IV infusions may produce rapid effects. Often faster & flexible protocols in experienced clinics (some patients respond when other treatments fail). Potentially lower direct drug cost (depending on formulation), but overall cost can still be high because of clinic fees and repeat sessions. Clinical experience: Many providers and clinics report beneficial outcomes, particularly for acute suicidal ideation or rapid symptom relief; however, standardization and long-term data vary.

For many patients, Spravato (esketamine nasal spray) represents a lifeline when traditional antidepressants fall short. However, no treatment is without risk, and you may have stumbled upon online stories that read “Spravato ruined my life.” In this article, we’ll explore: Why some patients have negative experiences Common and rare side effects of Spravato How to minimize risks When to seek help What makes treatment at Elevium different

Transcranial Magnetic Stimulation (TMS) is FDA-approved and widely considered a safe, effective treatment for depression, OCD, and other mood disorders. But, as with any therapy, individual experiences vary - and online, you may have come across forums or articles claiming “TMS made me worse.” At Elevium , we believe in open, honest communication about both the benefits and the potential challenges of treatment. In this article, we’ll cover: Why some patients report negative experiences The most common side effects How Elevium minimizes risk and enhances outcomes What to do if symptoms worsen How to make an informed, confident decision about TMS

When to Expect Results and Side Effects from Spravato