Compare Treatments for Treatment-Resistant Depression
No single treatment is best for everyone. Use the interactive tool to compare SAINT®, standard TMS, SPRAVATO®, ketamine and ECT side by side — then see if SAINT® is a fit, free.
Medically reviewed by Daniel Pietras, MD. Last updated November 3, 2026.
There is no single best treatment for treatment-resistant depression. The right choice depends on how quickly you need relief, how much time you can spend in clinic, your tolerance for side effects, and your insurance. SAINT® delivers the fastest reported remission in the fewest clinic days; SPRAVATO® and ketamine act quickly but often need ongoing maintenance; standard TMS and ECT take weeks but are widely covered. Use the tool below to compare two or three side by side.
The interactive comparison tool
Tick 2–3 treatments to compare them side by side:
SAINT®
- FDA status
- FDA-cleared (510(k)) for MDD in adults
- Time commitment
- 5 consecutive days (plus a mapping day)
- Time to response
- Days — average 2.6 days to remission
- Response / remission
- 79% reached remission (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary.
- Common side effects
- Headache, fatigue, scalp discomfort; small seizure risk
- Cost / coverage
- Starting at $25,000; may be covered (coverage varies by plan); free benefits verification
Standard TMS
- FDA status
- FDA-cleared for MDD
- Time commitment
- 6–9 weeks, 5 sessions/week (30–36 visits)
- Time to response
- Weeks — typically 3–5 weeks to notice change
- Response / remission
- Remission 17–32% (Janicak et al., J Clin Psychiatry 2010). Individual results may vary.
- Common side effects
- Scalp discomfort, headache; small seizure risk
- Cost / coverage
- Often covered by commercial plans and Medicare
This tool is a reference, not a recommendation. It does not score or rank treatments. The right choice depends on your diagnosis, history, and circumstances and is made at a consultation. Individual results may vary.
How to read the comparison
FDA status tells you whether a treatment has been formally cleared or approved for depression. "Off-label" means the drug is FDA-approved but not specifically for depression.
Time commitment is how many days or weeks you need to be in the clinic. SAINT® compresses treatment into five consecutive days; standard TMS and ECT spread sessions over weeks.
Time to response is how quickly people typically notice a change. "Response" means a meaningful improvement; remission means symptoms drop below the threshold for a depression diagnosis.
Cost / coverage is a general guide. Coverage varies by plan; we verify your benefits for free before you commit to anything.
When each option is usually considered
SAINT® is usually considered for adults with major depressive disorder who have not gotten adequate relief from antidepressant medication and want the fastest option in the fewest clinic days. SAINT® is FDA-cleared for MDD in adults whose depression has not improved enough on prior antidepressant medication. Neuro Wellness treats adults 22 and older. Learn more about SAINT®.
Standard TMS is often the first brain-stimulation option after medication fails, especially when insurance coverage is a priority and a six-week schedule is manageable. SAINT® vs accelerated TMS.
SPRAVATO® is considered when rapid relief is needed and ongoing in-clinic dosing is acceptable. It is FDA-approved for treatment-resistant depression and for major depressive disorder with acute suicidal ideation. SAINT® vs SPRAVATO®.
IV ketamine is used off-label for rapid, short-term relief, often while waiting for a longer-term treatment to take hold. SAINT® vs ketamine.
ECT remains one of the most effective treatments in psychiatry and is typically considered when other options have not worked or when rapid, high-intensity intervention is needed. It requires anesthesia and carries a known risk of memory problems. SAINT® vs ECT.
All five under one roof at Neuro Wellness
Neuro Wellness TMS Centers of America offers SAINT®, standard TMS, SPRAVATO®, IV ketamine, and psychotherapy in the same Coral Springs clinic. That means a combined or sequential plan — for example, starting ketamine for interim relief while arranging a SAINT® week, or following SAINT® with SPRAVATO® maintenance — can happen under one care team without being sent elsewhere. ECT is not performed on-site; if it is the right option for you, we coordinate a referral.
Neuro Wellness is a Verified SAINT® Provider in Coral Springs, Florida. SAINT® at Neuro Wellness starts at $25,000; coverage varies by plan, and we verify your benefits for free. Check my insurance or learn if it's a fit.
Full comparison table
| Treatment | FDA status | Time commitment | Time to response | Response / remission (cited) | Common side effects | Cost / coverage |
|---|---|---|---|---|---|---|
| SAINT® | FDA-cleared (510(k)) for MDD in adults | 5 consecutive days (plus a mapping day) | Days — average 2.6 days to remission | 79% reached remission (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary. | Headache, fatigue, scalp discomfort; small seizure risk | Starting at $25,000; may be covered (coverage varies by plan); free benefits verification |
| Standard TMS | FDA-cleared for MDD | 6–9 weeks, 5 sessions/week (30–36 visits) | Weeks — typically 3–5 weeks to notice change | Remission 17–32% (Janicak et al., J Clin Psychiatry 2010). Individual results may vary. | Scalp discomfort, headache; small seizure risk | Often covered by commercial plans and Medicare |
| Deep TMS (H-coil) | FDA-cleared for MDD (BrainsWay H-coil) | 6 weeks, 5 sessions/week | Weeks — typically 4–5 weeks | Remission ~32% (Levkovitz et al., World Psychiatry 2015). Individual results may vary. | Scalp discomfort, headache; small seizure risk | Often covered by commercial plans and Medicare |
| SPRAVATO® (esketamine) | FDA-approved for TRD and MDD with suicidal ideation | Induction: 2×/week for 4 weeks, then maintenance | Days to weeks — some response within 24 hours | Remission ~27% at 4 weeks (Daly et al., Mol Psychiatry 2019). Individual results may vary. | Dissociation, sedation, dizziness, nausea (REMS monitored) | Covered by many plans including Medicare |
| IV Ketamine (off-label) | Off-label use of an FDA-approved drug | 6 infusions over 2–3 weeks, then boosters | Hours to days — often within 24 hours | Response ~71% (Ivanova et al., J Affect Disord 2019). Individual results may vary. | Dissociation, elevated blood pressure, nausea | Generally not covered (off-label); self-pay |
| ECT | Established treatment; not a device clearance | 2–3 sessions/week for 3–6 weeks | Weeks — typically 2–4 weeks | Remission ~48% (UK ECT Review Group, Lancet 2003). Individual results may vary. | Memory problems, requires general anesthesia | Covered by most plans including Medicare |
Study designs and populations vary across these figures. Individual results may vary. A consultation is required to determine whether any treatment is appropriate for you.
Frequently asked questions
Which depression treatment works fastest?
SAINT® and IV ketamine both act within days rather than weeks. In the 2022 SAINT randomized trial, the average time to remission was 2.6 days (Cole et al., Am J Psychiatry 2022;179(2):132–141). IV ketamine can produce relief within hours, though its use for depression is off-label and the effect often requires maintenance dosing. Standard TMS and ECT typically take weeks. Individual results may vary.
Can I combine SAINT with Spravato or ketamine?
Yes. Neuro Wellness offers SAINT®, SPRAVATO®, and IV ketamine under one roof, so a combined or sequential approach is possible when clinically appropriate. Some patients use an accelerated TMS course for durable remission and add SPRAVATO® or ketamine for interim relief or maintenance. The specific plan is set at a consultation based on your diagnosis and history.
Which treatments does insurance usually cover?
Standard TMS, deep TMS, SPRAVATO®, and ECT are generally covered by commercial plans and Medicare. SAINT® may be covered, but coverage varies by plan and is reviewed case by case through prior authorization; we verify your benefits for free. IV ketamine for depression is off-label and is generally not covered. Self-pay and financing options are available.
Which is best for me?
There is no single best option — the right treatment depends on your diagnosis, how many antidepressants you have tried, how quickly you need relief, your tolerance for side effects, and your insurance. The interactive tool above lets you compare two or three treatments side by side, but a consultation with our clinical team is the only way to get a recommendation tailored to you. Learn if it's a fit.
Cited research
- Cole EJ, Phillips AL, Bentzley BS, et al. "Stanford Accelerated Intelligent Neuromodulation Therapy for treatment-resistant depression." Am J Psychiatry 2022;179(2):132–141. doi:10.1176/appi.ajp.2021.20101499
- Janicak PG, Nahas Z, Lisanby SH, et al. "Durability of clinical benefit with TMS in TRD." J Clin Psychiatry 2010.
- Levkovitz Y, Isserles M, Padberg F, et al. "Efficacy and safety of deep TMS for MDD." World Psychiatry 2015;14(1):64–73.
- Daly EJ, Singh JB, Fedgchin M, et al. "Efficacy and safety of intranasal esketamine adjunctive to oral antidepressant in TRD."Mol Psychiatry 2019;24(4):601–612.
- Ivanova-Starkova O, et al. "Ketamine for depression: a meta-analysis." J Affect Disord 2019.
- UK ECT Review Group. "Efficacy and safety of ECT in depressive disorders." Lancet 2003;361(9360):799–808.
SAINT® is not for everyone. It is contraindicated for people with non-removable magnetic-sensitive metal in or near the head, certain implanted devices, or increased intracranial pressure. Possible side effects include headache, fatigue, scalp discomfort and anxiety; TMS carries a small risk of seizure and, as with any depression treatment, a risk of worsening depression or suicidal thoughts. If you are in crisis, call or text 988.
SAINT® is a registered trademark of Stanford University, exclusively licensed to Magnus Medical, Inc. NWCOA is not affiliated with Stanford University.
See if SAINT® is a fit, free
No commitment. We'll review your situation, answer your questions, and help you understand whether SAINT® or another treatment is the right fit. One phone call — 954-827-9793.