Ketamine and TMS: Indications, Crossover, and Impact
- Katya Bownas RN, PMH-BC
- Feb 5
- 3 min read
Both ketamine therapy and transcranial magnetic stimulation have been up-and-coming promising treatments for treatment-resistant depression. They have shown effectiveness both as individual treatments as well as when used as a combined therapy. Alternative treatments such as ketamine and TMS for depression have arisen, at least in part, as a result of the limitations of medication to effectively treat depression. Medication often has unwanted side effects and many depressed patients do not respond adequately to them, making them ineffective for a large percentage of the population. When a patient has been suffering for a long time for depression and traditional treatments are ineffective, this kind of depression is known as treatment-resistant depression (TRD). As many as 35% of the 280 million patients globally diagnosed with depression are considered treatment-resistant to readily available medications. It is clear that new horizons for depression therapy are much needed. Both ketamine and TMS have been shown to do the essential work of improving plasticity in the brain, and have been shown to be a powerful therapeutic duo for depression.
Ketamine therapy typically involves scheduled intranasal doses of the medication ketamine. It appears in clinical studies and in practice to be overall very effective for people with treatment-resistant depression (TRD). With certain protocols, ketamine therapy can be effective for up to 70% of patients, giving it a much higher efficacy rate than traditional pharmacology. Ketamine also provides rapid relief from depressive symptoms, whereas antidepressant medications typically take 4-6 weeks to induce changes, making it a powerful therapy option for those struggling with acute suicidality and severe depression. However, like any medication, ketamine can produce undesired side effects such as dissociation, nausea, and blood pressure changes, meaning it is important to receive this treatment under the supervision of a trained professional. Furthermore, ketamine therapy does not seem to show the kind of durability as an anti-depressant as either medication or TMS. The effects seem to be relatively short lived, making it a particularly useful treatment for acute suicidality but not a long term solution for depression.
Transcranial magnetic stimulation (TMS) is magnetic stimulation of the brain with the goal of improving communication, plasticity, and overall function of the brain’s important structures that are involved with depression and other conditions. It has an efficacy rate of approximately 60% in reducing depressive symptoms for patients with TRD, making it highly effective for a majority of patients. Efficacy can be improved if adjustments to the treatment are made throughout treatment. It is also a very safe and well-tolerated treatment. Side effects are minimal and transient and can include mild mild twitching during treatment, slight headache during the initial treatment phase which generally resolves shortly after treatment has begun. Any side effects should be discussed with the treatment team and can almost always be resolved with adjustments to the treatment.
While TMS is highly effective for many patients, there is still a subset of patients, like with ketamine therapy, that do not respond adequately to TMS treatment. A conjunctive treatment known as CTK (Combination transcranial magnetic stimulation with ketamine) has been shown in studies to have a higher efficacy for patients than each of the treatments on their own, namely in patients for whom rTMS or ketamine therapy as a monotherapy did not effectively relieve depressive symptoms. This combination treatment may also improve longevity of symptom relief, with many treatment-resistant depression patients seeing complete remission of symptoms for up to a year following CTK. It also appears, based on a recent study review, that CTK for many patients had a more tolerable side effect profile than that of monotherapy with ketamine, with most patients experiencing no adverse effects while some reported temporary and mild symptoms such as nausea and vertigo.
While these treatment modalities may not be for everyone, if you or someone you know is struggling with treatment-resistant depression, it is important to know that there are therapies out there that may provide relief. There is research being done every day to find new protocols, treatments, and therapies to help those in need. Talk to your doctor, reach out to your local TMS clinic, and explore your options - it is possible to feel like yourself again!
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