TMS vs. Ketamine for Depression and Anxiety: How Clinicians Help You Choose
- Anne Lewis
- Jun 11
- 5 min read
When medications for depression or anxiety have not provided enough relief, it is natural to wonder what comes next.
For many people in Cincinnati, Dayton, and Indianapolis, that next step involves exploring advanced treatment options like TMS Therapy or IV ketamine treatment.
Both are evidence-informed treatments used for people whose symptoms have not responded well to traditional approaches.
But how does a clinician decide which one is the right fit?
And what does progress actually look like once treatment begins?
Anne Lewis, a nurse practitioner at The Anxiety Center, walks through how these decisions are made and what patients and families can expect along the way.
When Do Clinicians Recommend TMS or Ketamine Instead of Adjusting Medications?
The conversation about advanced treatment usually starts when medications have not been working.
For some people, that means trying several different medications without enough improvement.
For others, it means experiencing significant side effects that made staying on a medication difficult or unsustainable.
According to Anne, both TMS and ketamine can be appropriate options for people dealing with depressive disorders or anxiety when traditional medication management has not provided adequate relief.
"Usually if people have tried several medications and not had much success," Anne explains, "then we talk about whether they'd be interested in TMS, Spravato, or ketamine."
This conversation is not about giving up on treatment.
It is about finding the approach that fits the person's actual situation and symptoms.
How Do Clinicians Help Patients Decide Between TMS and Ketamine?
The recommendation depends primarily on what the patient is dealing with as their main concern.
For severe or treatment-resistant depression, including cases involving suicidal ideation, Anne typically recommends IV ketamine first.
"Ketamine would be the quickest and best approach if possible," she explains, "if it's feasible for the patient and they're medically okay to do that treatment."
Spravato treatment is also a strong option for depression, though results typically take longer and involve insurance approval and additional monitoring requirements.
TMS Therapy is a 36-session treatment, which usually spans about seven weeks.
Most patients do not begin noticing improvement until partway through the treatment course.
When anxiety is the primary concern, TMS may actually be the better starting point.
"Both ketamine and Spravato have mixed results for anxiety," Anne notes, "so if someone is dealing a lot with anxiety, TMS might be a better route for them."
When a patient has both depression and anxiety, Anne and the team often recommend starting with ketamine or Spravato first and then adding TMS afterward.
"It kind of jumpstarts the process," she explains, "and then TMS builds on that."
How Do Clinicians Measure Whether TMS or Ketamine Is Working?
Progress is tracked through a combination of clinical tools and real-life observations.
The GAD-7 is a standardized anxiety rating scale that gives clinicians a measurable baseline to compare over time.
For TMS, the rating scale is typically completed at the start of treatment, once during the middle, and again at the end.
These scores give a clear picture of where someone started and how things have shifted.
But Anne is equally focused on what those scores do not always capture.
"Sometimes people underrate or overrate their symptoms," she explains.
"So we also look at day-to-day life.
Are you coping better?
Are you feeling less overwhelmed?
Are your emotions more stable?
Are you doing self-care that maybe you couldn't do before?"
When family members attend appointments, their observations can also be a meaningful part of the picture.
Hearing from someone who sees the patient day to day can offer a perspective that a rating scale alone cannot provide.
What If a Patient Does Not Feel Like Treatment Is Working?
This is one of the most common concerns that comes up during treatment.
And it is one of the most important things a clinician can help a patient work through.
Anne is clear that progress is individual and that comparisons to other patients are not useful or accurate.
"It's not a comparison to everyone around them," she explains. "It's where did you start, and how are you doing now?"
For some people, the changes are gradual and easy to overlook.
Anne shared an example of a patient who was receiving IV ketamine treatment and did not believe it was helping.
When she asked him about his specific depressive symptoms, which for him were primarily physical, including low energy and difficulty getting up and doing things, he paused.
He realized he had actually been out on his family's sheep farm doing physical work he had not been able to do before.
He had not connected that shift to his treatment until she helped him look for it.
"Helping people navigate how their symptoms show up, whether physically, emotionally, or relationally, really helps them recognize progress," Anne says.
Having a clinician alongside you throughout the process is a meaningful part of how treatment works.
What Kind of Support Do Patients and Families Receive Throughout Treatment?
Support at The Anxiety Center extends well beyond the treatment session itself.
Patients can reach the care team through text, phone, or email between appointments.
If a message needs to reach a specific nurse practitioner, it is relayed and addressed as quickly as possible.
"We are always accessible and right there with the patient as they need it," Anne explains.
Clinicians are present throughout to help ground patients and ease any anxiety that comes with that experience.
"They're not alone," Anne says. "They're fully supported during treatment."
If a patient experiences a side effect like nausea after getting home, that information is used to adjust care for the next session.
"There's a clear, direct, constant line of communication with all of the clinicians involved," she notes.
For family members, the same open communication applies.
Family members often have their own questions about timelines and what signs of improvement to watch for.
The team helps them understand that progress may show up in areas they are not expecting.
A parent focused on one specific symptom may not notice improvement happening in another area.
Helping families see the broader picture is part of the care.
Taking the Next Step
If medications have not provided the relief you were hoping for, it may be worth learning whether TMS, ketamine, or Spravato could be a fit.
An intake evaluation can help determine which option may be appropriate based on your symptoms, medical history, and treatment goals.
Patients and families in Cincinnati, Dayton, and Indianapolis can contact The Anxiety Center to learn more and schedule a free consultation.
