By Adarsh K. Gupta, MD | Sleep, TMS & Wellness Psychiatry
You are not alone—and severe depression is treatable. When medications and psychotherapy have not provided enough relief, newer interventions can sometimes begin improving depressive symptoms much faster. Two important options are accelerated TMS and Spravato® (esketamine).
Accelerated TMS: Targeting Depression’s Brain Networks
Transcranial magnetic stimulation (TMS) is a noninvasive treatment that uses magnetic pulses to stimulate brain networks involved in mood regulation. Standard TMS is usually delivered five days a week for approximately six weeks. Accelerated TMS provides several carefully spaced sessions each day, allowing treatment to be completed over a much shorter period for appropriately selected patients.
Treatment commonly targets the left dorsolateral prefrontal cortex, which is connected with deeper mood-regulation networks. Advanced MRI-guided targeting can help select a more individualized treatment location. Stanford studies and newer clinical reports show that intensive, personalized TMS can produce rapid improvement in severe treatment-resistant depression; some studies also report reductions in suicidal thinking. Accelerated TMS is not FDA-cleared specifically as an anti-suicide treatment, and urgent suicide risk still requires immediate safety intervention.
Spravato®: A Rapid-Acting Treatment for Severe Depression
Spravato® is an FDA-approved esketamine nasal spray for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. It works through the brain’s glutamate system and may improve severe depressive symptoms within hours to days for some patients.
Spravato must be self-administered in a certified medical setting under professional supervision. Blood pressure and clinical status are monitored, and patients remain for observation for at least two hours. Although it can rapidly improve depressive symptoms during a suicidal crisis, studies have not established that Spravato independently prevents suicide or directly reduces suicidal behavior. It must be part of a comprehensive treatment and safety plan.
Spravato treatment administered under the supervision of the STW clinical team.
Can TMS and Ketamine-Based Treatment Be Combined?
For selected patients with difficult-to-treat depression, a psychiatrist may consider TMS and ketamine-based treatment within the same overall plan. These approaches affect depression through different and potentially complementary mechanisms. Early reports are encouraging, but combination evidence remains limited; treatment should follow an individualized psychiatric and medical assessment.
Rapid, Personalized Care at STW Psychiatry
At Sleep, TMS & Wellness Psychiatry, we recognize that people with severe depression should not wait unnecessarily for evaluation. Our Great Neck center offers:
- Standard and accelerated TMS, including MRI-guided targeting
- Spravato treatment in a private, medically monitored setting
- Comprehensive psychiatric evaluation and medication management
- Integration of psychotherapy, sleep care, and wellness interventions
- Suicide-risk assessment and an individualized safety plan
Our team will make every reasonable effort to arrange an evaluation and begin appropriate treatment at the earliest possible time. Timing depends on clinical urgency, treatment suitability, insurance authorization, and safety needs.
THERE IS MORE THAN ONE PATH FORWARD
Depression may make recovery feel impossible. Modern psychiatry tells us something different: even after previous treatments have failed, meaningful improvement may still be possible. Asking for help is the first step.
Contact Sleep, TMS & Wellness Psychiatry
Phone: (516) 684-9535
Website: www.dragupta.com
Office: 560 Northern Blvd, Suite 206, Great Neck, NY 11021
Selected Evidence
- Cole EJ, et al. Stanford Neuromodulation Therapy for treatment-resistant depression. American Journal of Psychiatry. 2022.
- Li B, et al. Targeting suicidal ideation in major depressive disorder with Stanford Accelerated Intelligent Neuromodulation Therapy. 2024.
- U.S. Food and Drug Administration. Spravato® (esketamine) Prescribing Information. 2025.
- Arubuolawe OO, et al. Combination of transcranial magnetic stimulation and ketamine for treatment-resistant depression: systematic review. 2024.
