*The FDA has not approved intravenous ketamine or NAD+ for the treatment of any psychiatric or pain condition. These articles reference off-label use. Like all medical treatments, the discussed therapies carry risks and benefits. Speak with a doctor at Clarus Health to learn if these therapies may be right for you.

Ketamine Therapy
Apr 28, 2024

Ketamine vs TMS: what's the difference

Dr. Kaveh explains the difference between TMS and IV Ketamine so you can better understand which therapy is right for you

Ketamine vs TMS: what's the difference

15-30% of patients with depression suffer from "treatment-resistant depression." IV Ketamine is a powerful tool in treating depression, anxiety, PTSD, and chronic pain. How does transcranial magnetic stimulation compare to IV Ketamine?

What is Transcranial Magnetic Stimulation (TMS)?

TMS a type of neuromodulation. This neuromodulation involves a coil of alternating current placed against the skull designed to induce a rapidly alternating magnetic field several centimeters below the skull bone and in the upper layers of the brain. The magnetic waves stimulate electrical activity in select brain regions. These magnetic pulses cause changes in prefrontal and limbic regions of the brain that are believed to be involved with depression. The electrical currents may also disrupt communication between these regions, allowing for a break from depressive symptoms. There is also evidence that this disruption can be helpful in OCD and anxiety. There is tremendous variability in the different TMS protocols used, but many start with daily sessions over 4-6 weeks (20-30 sessions). Results are observed within, and sustained for, several weeks. We don't yet understand how TMS treats depression. You can learn more about TMS here.

Who Cannot Receive TMS?

Unlike IV Ketamine, several patient populations cannot receive TMS for safety reasons, including patients who:

  • are at increased risk of seizures
  • have implanted metallic hardware, such as clips, electrodes, plates, and stimulators (eg deep brain stimulators and vagus nerve stimulators)
  • metal fragments (eg bullets)
  • cochlear implants
  • implanted electrical devices, including cardiac pacemakers, implantable cardioverter-defibrillators, intracardiac lines, and medication pumps
  • tattoos in the head or neck made with ferromagnetic-containing ink
  • unstable general medical disorders

What is IV Ketamine?

IV Ketamine is a rapid-acting medication used for over 50 years in children and adults for anesthesia. It affects the activity of glutamate, an important neurotransmitter in the brain. Ketamine stimulates a powerful "learning process" in the brain, called neuroplasticity, that allows for new insights and realizations in the root cause of our pain. IV Ketamine allows for a rapid-acting and highly customized treatment because the rate of the Ketamine infusion can be changed throughout and between every infusion. Unlike other medications used to treat depression, IV Ketamine allows for addressing the root causes of depression, anxiety, PTSD, and other conditions. By addressing the root causes, patients often find sustained symptom relief for weeks, months, or years. Integration therapy is an important component to IV Ketamine therapy to explore the subconscious that is revealed through the experience. IV Ketamine is the fastest-acting and most efficient form of Ketamine therapy. Most protocols involve 1-2 sessions a week for 2-4 weeks. Improvements in mood can occur within hours to days (unlike weeks for TMS).

Which is better: IV Ketamine or TMS?

There are many differences between IV Ketamine and TMS, including the treatment experience, effectiveness, and side effects.

Treatment Experience: Ketamine vs TMS

Patients receiving IV Ketamine enter a dissociative state. Patients find this experience pleasant although the experience may not be necessary for the improvements in depression and anxiety. Many realizations and understandings often present to patients during this experience. These are sometimes likened to "spiritual experiences." TMS does not induce such an altered state of consciousness. Neither experience is painful, though side effects from TMS include scalp pain at the site of stimulation. Unfortunately, in one study, patients receiving TMS were 4 times more likely to discontinue TMS because of side effects (compared to controls). Unlike TMS, IV Ketamine requires placing a small IV. Numbing can help minimize the discomfort from both.

Effectiveness of Ketamine vs TMS for Depression

There are very few studies comparing IV Ketamine vs TMS. This is partly because IV Ketamine has been used for so long that it has lost patent-status by pharmaceutical companies, and without this patent-status, funding is scare to perform for such large-scale studies. You can watch Dr. Kaveh's video explaining the FDA approval process.

Available studies show neither IV Ketamine nor TMS to be significantly different in outcomes for depression. However, there are very few studies on TMS for other conditions, such as PTSD and addiction.

IV Ketamine is unique, however, in its ability to foster a sustained change in self representation. Rather than a "band-aid" approach, the goal of a holistic Ketamine therapy plan is to address the root causes of pain and "feeling stuck." This is different than the approach of TMS. You can read more about the long-term changes that are possible with IV Ketamine in Dr. Kaveh's article.

Complications from TMS and IV Ketamine

Fortunately, complications from medically supervised TMS and IV Ketamine treatments are rare. The most serious complication from TMS is seizures as a result of the magnetic stimulation. The most serious complication from IV Ketamine is an unpleasant experience. Appropriate patient selection is the most important step in reducing patient side effects, especially for TMS. Preparation for IV Ketamine is important not only to reduce side effects, but to also achieve the longest symptom relief.

The Bottom Line: IV Ketamine vs TMS

Given that both IV Ketamine and TMS can provide similar short-term benefits in treating depression, the main considerations to decide between these include:

  • Do you want to address the root causes of your pain, such as past traumas? IV Ketamine is the winner
  • Is there urgency in your treatment? IV Ketamine is faster acting than TMS
  • Are you opposed to "spiritual" experiences from an altered state of consciousness? If so, TMS is more appropriate
  • Do you have a history of seizures or any metal in your body (implants, pacemakers, tattoos, etc.)? You likely will not be a candidate for TMS
  • Have you had a history of psychosis or schizophrenia? You likely will not be a candidate for ketamine
  • Are you struggling with multiple conditions (depression, anxiety, PTSD)? IV Ketamine can better address these conditions holistically
  • Is there a history of chronic pain? IV Ketamine is the most direct treatment for combined physical and psychological pain
  • Can you commit to 20-30 sessions over 2-4 weeks? If not, TMS may not be suitable for you (Ketamine requires 1-2 sessions a week for 2-4 weeks)
  • Insurance coverage varies widely for both therapies, so you need to speak with your provider

Find Your Healing Potential

As the medical community continues to explore and understand the full potential of Ketamine and TMS therapies, it's clear that your decision should be based on both scientific evidence and a compassionate approach to patient care. IV Ketamine Therapy, with its proven track record and adaptability, remains at the forefront of providing relief for those grappling with some of the most challenging mental health conditions. Schedule a free consultation with Clarus Health to learn if IV Ketamine Therapy may be effective in uncovering your healing capacity.

Anthony Kaveh MD

Anthony Kaveh MD

Dr. Kaveh is a Stanford and Harvard-trained anesthesiologist and integrative medicine specialist. He has over 800,000 followers on social media and has guided hundreds of patients throughout transformative healing experiences. He is an authority on Ketamine, NAD, and SGB therapies. He is a registered continuing education lecturer in the Bay Area.