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Most people who have struggled with a treatment-resistant mental health condition like depression or OCD are willing to try just about anything to find relief. If you’re one of those people you’ve probably heard about transcranial magnetic stimulation (TMS) and ketamine therapy.
Both are considered to be relatively new treatments compared to standard treatment protocols, but they are very promising nonetheless. If you’re trying to decide if either treatment is worth exploring, this comparison guide will help you better understand how each therapy works and how effective they are at treating treatment-resistant depression (TRD) among other conditions.
Ketamine Therapy vs TMS: How It Works
Ketamine therapy and TMS have both proven to be effective at treating depression, but they do so in different ways. Understanding how each treatment works is a big factor in determining which one might be more effective.
It’s important to note that researchers are still conducting studies to gain a better understanding of the mechanisms that are at play and how these therapies impact the brain. However, we have discovered a lot already. Here’s a brief overview of what we do know.
How Ketamine Therapy Works
Although researchers are still learning more about how ketamine therapy works, a lot has been discovered in recent years. We now know that ketamine affects the brain in profound ways.
Ketamine that’s administered via IV, nasal spray or sublingual tablets binds to the NMDA receptor proteins of cells, which blocks a neurotransmitter called glutamate. This increases the activity of glutamate in the area of the brain called the frontal cortex. Unlike traditional antidepressants, ketamine does this without having to increase serotonin first. Ketamine can also trigger the growth of neural connections and enhance neuroplasticity (the brain’s ability to adapt and change). This allows patients to essentially rewire their brain to form different thought patterns and break habits.
How Transcranial Magnetic Stimulation Works
In a transcranial magnetic stimulation session magnetic pulses are repetitively delivered to stimulate nerve cells in the brain. It’s a noninvasive treatment in which an electromagnetic coil is placed on the forehead. Electromagnetic pulses are painlessly delivered through the coil to portions of the brain that control mood. The pulses stimulate the nerve cells in those brain regions. It’s believed that this increases brain activity, which reduces depression symptoms.
Ketamine Therapy vs TMS: Effectiveness
There are a number of studies looking at each therapy separately that proves their efficacy for treating depression. One of the most insightful studies specifically gauged how well ketamine therapy treated TRD compared to TMS.
What researchers found was that both ketamine therapy and TMS produced significant results. Some of the most important findings were:
- Ketamine significantly reduced pre-treatment scores for HDRS, HAM-A and BDI-II.
- TMS significantly reduced pre-treatment scores for HDRS, HAM-A and BDI-II.
- 25-33.3% of participants were ketamine responders (participants with a 50% or higher reduction in scores) and 58.3-75% were remitters with significantly lowered scores.
- 8.3-25% of participants were TMS responders and 66.7-75% were remitters.
- Only 16.7% were non-responders to ketamine for one measurement. In all other measurements participants were either responders or remitters.
- 8.3-16.7% were non-responders to TMS for two of three measurements.
This research and many other clinical studies show ketamine’s effectiveness as well as that of TMS, though ketamine therapy appears to be slightly more effective in terms of addressing treatment-resistant depression. However, both can be effective at achieving total response and remission.
Ketamine Therapy vs TMS: Side Effects
A benefit of both ketamine therapy and TMS is they have few side effects. The vast majority of patients report having no side effects at all and only a small percentage have to discontinue treatment due to side effects. Extensive research looking at anesthetic properties have proven ketamine therapy is very safe, and a growing body of research is doing the same for TMS.
Common Ketamine Therapy Side Effects
- Nausea
- Disassociation
- Drowsiness
- Headaches
Less common ketamine therapy side effects include:
- Psychotic episodes
- Blurred vision
- Hypo- or hypertension
Common TMS Side Effects
- Headaches
- Tingling in the face
- Twitching in face muscles
- Lightheadedness
- Skin or scalp discomfort at treatment site
Less common TMS side effects can include:
- Seizures
- Manic episodes
- Hearing loss (without adequate hearing protection)
The majority of side effects are short-term, being experienced either during the treatment or shortly after. Since ketamine therapy and TMS are relatively safe, either treatment is worth considering if other therapies haven’t worked.
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