Compare Treatments for Depression & OCD - Louisville, KY
Compare Your
Treatment Options
When someone is struggling with depression, OCD, or related conditions, choosing a next step can feel overwhelming. At Bluegrass Advanced Mental Health, we offer an integrated toolkit - from psychotherapy and medication to evidence-based interventional options such as TMS and Spravato (esketamine).
Below is a concise comparison to help you understand how each approach works, who it helps, how quickly it acts, and what to expect.
Treatment Comparison
Compare treatment options side by side to help inform your decisions.
| Treatment | Success Rates | Timeline | Insurance Coverage | Common Side Effects | Best For |
|---|---|---|---|---|---|
| Deep TMS BrainsWay H-Coil | Response ~80%. Remission ~66%. |
Improvement in 2–4 weeks. Treatment duration 4–6 weeks (20–36 daily sessions). |
Typically covered. Usually requires prior authorization and documentation of 2+ failed antidepressant trials. FDA-cleared indication increases coverage likelihood. |
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| Accelerated TMS (BrainsWay SWIFT) iTBS Protocol | Response ~88%. Remission 78%. |
Improvement in 1–2 weeks. Treament duration 1–2 weeks (multiple daily sessions). |
Coverage varies / typically self-pay. Prior authorization required; coverage not guaranteed as the protocol is newer. May require out-of-pocket payment or appeal. |
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| Spravato Esketamine nasal spray + 1 oral antidepressant | Response ~69% at 4 weeks. Remission ~52% by week 4 (MADRS ≤ 12). |
Improvement within hours to days. Initial 2× per week for 4 weeks. Maintenance weekly to monthly. |
Typically covered. Requires prior authorization, documentation of 1+ failed antidepressant trial, and can be used with oral antidepressant or as monotherapy. Must be administered in a REMS-certified clinic with 2-hour observation. |
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| Oral Antidepressants SSRIs, SNRIs, others | Response 50–55%+. Remission ~35–45%+. |
Improvement in 4–6 weeks (full effect 8–12 weeks). Ongoing; 6–12 months minimum after remission. |
Standard coverage. Most medications covered with standard copay; prior authorization may be required for newer or brand-name medications. Generic options typically cost less. |
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| Psychotherapy CBT, IPT, others | Response ~45%. Remission 30–40%. |
Improvement in 6–8 weeks with consistent sessions. Treatment duration 12–20 sessions (3–6 months); may continue longer term. |
Standard coverage. Typically covered under mental health benefits; copay or coinsurance applies per session. Some plans have session limits — verify benefits for specifics. |
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Response ~80%. Remission ~66%.
Improvement in 2–4 weeks. Treatment duration 4–6 weeks (20–36 daily sessions).
Typically covered. Usually requires prior authorization and documentation of 2+ failed antidepressant trials. FDA-cleared indication increases coverage likelihood.
- Mild headache at treatment site
- Scalp discomfort during session
- Temporary lightheadedness
- Muscle twitching during stimulation
- Treatment-resistant depression
- OCD unresponsive to medication
- Patients seeking a non-medication approach
Response ~88%. Remission 78%.
Improvement in 1–2 weeks. Treament duration 1–2 weeks (multiple daily sessions).
Coverage varies / typically self-pay. Prior authorization required; coverage not guaranteed as the protocol is newer. May require out-of-pocket payment or appeal.
- Mild headache
- Scalp discomfort
- Fatigue from intensive schedule
- Temporary muscle twitching
- Rapid symptom relief needed
- Limited time for standard TMS
- Treatment-resistant depression
Response ~69% at 4 weeks. Remission ~52% by week 4 (MADRS ≤ 12).
Improvement within hours to days. Initial 2× per week for 4 weeks. Maintenance weekly to monthly.
Typically covered. Requires prior authorization, documentation of 1+ failed antidepressant trial, and can be used with oral antidepressant or as monotherapy. Must be administered in a REMS-certified clinic with 2-hour observation.
- Dissociation during treatment
- Dizziness or sedation
- Nausea
- Increased blood pressure (temporary)
- Altered perception
- Treatment-resistant depression
- Need for rapid symptom relief
- Acute suicidal ideation
Response 50–55%+. Remission ~35–45%+.
Improvement in 4–6 weeks (full effect 8–12 weeks). Ongoing; 6–12 months minimum after remission.
Standard coverage. Most medications covered with standard copay; prior authorization may be required for newer or brand-name medications. Generic options typically cost less.
- Weight gain or loss
- Sexual side effects
- Nausea (initial weeks)
- Sleep changes
- Emotional blunting
- First-line depression treatment
- Mild to moderate depression
- Anxiety comorbidity
Response ~45%. Remission 30–40%.
Improvement in 6–8 weeks with consistent sessions. Treatment duration 12–20 sessions (3–6 months); may continue longer term.
Standard coverage. Typically covered under mental health benefits; copay or coinsurance applies per session. Some plans have session limits — verify benefits for specifics.
- Emotional discomfort when processing difficult topics
- Temporary increase in distress
- Time commitment required
- Mild to moderate depression
- Learning coping strategies
- Addressing life stressors
- Combination with medication
Insurance coverage and costs vary by plan and individual circumstances. This comparison is for educational purposes only and does not replace personalised medical advice.
Treatment Options - Frequently Asked Questions
Q. TMS or Spravato: which is better for treatment-resistant depression?
A. Neither is universally better; they suit different situations. Spravato works fastest, with many patients improving within 24 hours, but requires twice-weekly in-clinic visits with two-hour monitoring and a ride home. TMS takes two to four weeks to show benefit but involves no medication, no sedation, and you drive yourself home. Spravato is often chosen when relief is needed urgently, including acute suicidal ideation. TMS is often chosen by patients who want a non-drug approach or cannot tolerate medication side effects. Some patients use both. Dr. Roth and Nurse Woods make this recommendation based on your history, urgency, medical profile, and preferences.
Q. Can I do TMS and stay on my antidepressant?
A. Yes. Most patients continue their existing medications throughout TMS, and many find TMS improves how well their medication works. We coordinate with your prescribing physician. Some patients later reduce or stop medications after a successful course, always as a joint decision with your care team.
Q. What if TMS does not work for me?
A. Roughly one in five patients does not respond meaningfully to TMS, and we tell you that upfront. We track your progress with validated symptom measures throughout the course, so we know within weeks rather than months. If you are not responding, we adjust the protocol, and if that does not help, we discuss alternatives including Spravato, medication changes, or a different TMS approach. Not responding to one treatment does not mean you are out of options.
Q. Which depression treatment does insurance cover?
A. Oral antidepressants and psychotherapy are covered under standard mental health benefits. Standard TMS and Spravato are covered by most major commercial plans, Medicare, and Tricare when medical criteria are met, generally documented inadequate response to two or more antidepressants, and both usually require prior authorization. Accelerated TMS is typically not yet covered and is self-pay. Our Patient Care Team handles verification and prior authorization for you.
Q. Which depression treatment works the fastest?
A. Spravato, typically within 24 hours to a few days. Accelerated TMS is next, with improvement often inside one to two weeks and a median time to remission of 21 days. Standard TMS generally takes two to four weeks. Oral antidepressants take four to six weeks for initial effect and eight to twelve weeks for full benefit. Psychotherapy typically shows benefit at six to eight weeks with consistent sessions.
