SAINT® TMS vs SPRAVATO®: Understanding the Differences

SAINT® is a non-invasive brain stimulation device treatment. It uses magnetic pulses — delivered through a coil placed on the scalp — to stimulate a specific brain region linked to mood. No drug enters the body. The target is personalized using an fMRI scan taken before treatment begins. SAINT® is FDA-cleared for adults with major depressive disorder (MDD) whose depression hasn't improved enough on prior antidepressant medication.

SPRAVATO® (esketamine) is a prescription medication — a nasal spray form of esketamine, a derivative of ketamine. It is FDA-approved as an adjunct (add-on) to an oral antidepressant for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. It is self-administered under supervision at a certified healthcare setting enrolled in the SPRAVATO REMS program.

SAINT® is delivered while you sit awake in a chair. A coil on the scalp delivers magnetic pulses — ten sessions per day over five consecutive days, with about 50-minute breaks between sessions. No anesthesia or sedation is used. You can generally drive yourself to and from the clinic.

SPRAVATO® is self-administered as a nasal spray at the clinic under the supervision of a healthcare provider. Because it can cause sedation and dissociation, you remain at the clinic for at least two hours of monitoring after each dose, and you cannot drive until the next day. A driver is required for each SPRAVATO® appointment.

SAINT® compresses the entire treatment into one week: 50 sessions over five consecutive days. After the week, there is no ongoing in-clinic treatment schedule, though follow-up visits help track your response.

SPRAVATO® is an ongoing treatment. The typical induction phase is twice weekly for four weeks (eight sessions), followed by a maintenance phase with less frequent doses. The full course spans weeks to months, with continued clinic visits.

SPRAVATO® carries a Risk Evaluation and Mitigation Strategy (REMS) because of the risks of sedation, dissociation, and blood pressure changes. Each dose must be administered at a REMS-certified healthcare setting, followed by at least two hours of monitoring. Patients cannot drive after a session. NWCOA is a REMS-certified site.

SAINT® requires no post-session monitoring — you return home after each day. However, SAINT® does require an MRI scan before treatment to personalize the brain target, so people who cannot have an MRI are not candidates for SAINT®.

SAINT®'s most commonly reported side effects are headache and scalp discomfort, which usually fade within days. TMS carries a small risk of seizure.

SPRAVATO®'s common side effects include dissociation, dizziness, nausea, sedation, and increased blood pressure. Because of these effects, monitoring is required after each dose.

Both are options for adults with treatment-resistant depression. SAINT® requires MRI safety screening — people with non-removable magnetic-sensitive metal in or near the head, certain implanted devices, or increased intracranial pressure are not candidates. SPRAVATO® has its own contraindications, including aneurysmal vascular disease. A psychiatric evaluation determines which may be appropriate for you. NWCOA treats adults 22 and older.

Durability — how long the improvement lasts — is a key question for both treatments. In the 2022 SAINT® randomized trial, 79% of participants reached remission, with outcomes tracked over several weeks of follow-up (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary, and some people may need additional or maintenance treatment.

SPRAVATO® is designed as an ongoing treatment with a maintenance phase, reflecting that its effects are sustained through continued dosing. The maintenance schedule is adjusted based on your response. Neither treatment is a one-time fix; both may require follow-up. Your psychiatrist can discuss what follow-up looks like for each and what to expect based on your situation.

SAINT® at NWCOA starts at $25,000. It uses Category III CPT codes and is typically self-pay, though coverage may be available depending on your plan. We verify your benefits for free and offer financing on a case-by-case basis, discussed during your consultation.

SPRAVATO® may be covered by insurance for its FDA-approved indications, subject to prior authorization and plan terms. Coverage varies by plan for both treatments. Neuro Wellness verifies benefits for both. Learn more about insurance coverage for SAINT® and financing options.

Yes, in some cases. NWCOA offers both SAINT® and SPRAVATO® in the same clinic, so your psychiatrist can coordinate care if combining or sequencing the two makes clinical sense for you. Some patients use one as a follow-on after the other, or as an adjunct. Whether combining is appropriate depends on your diagnosis, history, and response — and should be discussed with your provider.

Because both are available under one roof, you don't have to choose between clinics. Your care team can help you decide which to start with and whether adding the other later makes sense. See if SAINT® is a fit or check your insurance.

SAINT® may fit adults with major depressive disorder who haven't improved enough on antidepressant medication and who prefer a non-invasive, device-based, one-week treatment. It requires an MRI and five full days at the clinic.

SPRAVATO® may fit adults with treatment-resistant depression (as an adjunct to an oral antidepressant) or those with acute suicidal ideation. It requires ongoing clinic visits, a driver for each session, and REMS-certified monitoring.

Neither is universally recommended. The right choice depends on your diagnosis, history, side-effect tolerance, schedule, and insurance. A psychiatric evaluation at NWCOA can help determine which — or whether a combination — is appropriate. Learn more about treatment-resistant depression.