How Are Ketamine and TMS Used Together?

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How Are Ketamine and TMS Used Together?

In 2020 alone, about 21 million American adults suffered from at least one major depressive episode — nearly 8.5% of the population. Medication has come a long way in successfully treating depression symptoms, but getting the right dosage and schedule takes trial, error, and time. For many, antidepressants and psychotherapy prove to be a winning combo that enables them to return to work and re-engage in relationships and activities.

Unfortunately, up to 33% don’t respond to these approaches, leaving millions searching for relief. Treatment-resistant depression calls for next-level methods that address the underlying cause from a different perspective.

Two innovative, evidence-based treatments offer hope and healing for those with treatment-resistant depression: ketamine and transcranial magnetic stimulation (TMS). Dr. Karen Giles offers both at Breakthru Psychiatric Solutions in Sandy Springs, Georgia. Here’s a look at the individual treatments and how they work together.


In 1970, ketamine was FDA-approved as an anesthetic, so it has been around for decades and is well-known in the medical field. However, researchers have found it can be used off-label at lower doses as a highly effective and rapid acting antidepressant, especially in acute and severe depressive disorders. Dr. Giles offers two forms of ketamine: intravenous (IV) and nasal spray.

IV Ketamine

As the name suggests, IV ketamine is administered intravenously and goes directly into your bloodstream. A thin needle is inserted into the vein in your arm to infuse the medication under Dr. Giles’s care. IV ketamine sessions typically take 50-60 minutes, and you’ll likely feel the positive effects immediately. When IV ketamine is the sole treatment, most folks need at least 6 treatments over 3 weeks to experience remission of their depression, followed by monthly maintenance treatments.


Another form of ketamine, Spravato (esketamine), is FDA-approved for adults with treatment-resistant depression or major depressive disorder with suicidal thoughts or actions when used in addition to an oral antidepressant. Spravato uses a different delivery system and can only be administered at certified treatment center, like Breakthru Psychiatric Solutions. While in the clinic, you will  self-administer the medication through a nasal spray device that coats your sinus passages and enters your system quickly while under close observation by Dr. Giles for 2 hours. Spravato requires 8 treatments in the first month followed by 4 weekly treatments.

Transcranial magnetic stimulation

TMS treats depression by stimulating the nerve cells in the portion of your brain that controls your mood. Dr. Giles places a device containing magnetic coils on your head and activates an electromagnetic current. The energy painlessly penetrates your brain with magnetic pulses and activates the area involved in depression.

The FDA has approved TMS as safe and effective for treatment-resistant depression, and studies show that multiple sessions — 5 treatments per week  for 6 weeks — deliver significant symptom relief and remission. The results from TMS often last 6 months to a year or longer.

Combined ketamine and TMS treatment

Independently, ketamine and TMS offer real relief for people with depression, but together, they can provide the best of both worlds — immediate and long-term results.

Research shows that TMS produces neural changes in the frontal and limbic areas of the brain, which are associated with major depressive disorder, resulting in better synaptic functioning and connectivity. However, it takes multiple sessions over several weeks to induce results that are long-lasting.

Ketamine triggers immediate results, so you can feel more like yourself while undergoing TMS. The one-two punch of both approaches may accelerate your TMS results and decrease the number of sessions needed, although individual responses vary.

To learn more about combination ketamine and TMS therapy, contact us online or by phone to schedule a consultation with Dr. Giles.