By Diana Ghelber, MD · October 23, 2026
Different treatments can have a place in the same plan. The reason for each should be clear.
When one treatment has not brought enough relief, it is natural to wonder whether another approach could help—or whether two treatments might work together.
TMS and IV ketamine are different treatments. Choosing between them, using them sequentially, or considering both requires an individual assessment.
Different experiences of treatment
TMS uses magnetic stimulation and is delivered while you are awake, without anesthesia. Improvement generally develops over a course of treatment.
IV ketamine is administered with clinical monitoring. Some patients experience improvement quickly, but the response may not last, and follow-up planning matters.
IV ketamine is not FDA-approved for depression; this use is off-label. It is distinct from intranasal esketamine, which has its own FDA-approved indications and requirements.
Why discuss both?
For selected patients, a clinician may consider one treatment after a partial response to another, or consider a plan involving both. That decision should have a clear clinical rationale.
Research on combined TMS and ketamine treatment is still developing. We cannot assume that combining treatments will produce a better result for a particular person, or that ketamine will provide rapid relief followed by lasting improvement from TMS.
A plan should include more than the first treatment
Before recommending either approach, we review your diagnosis, previous responses, medical conditions, medications, and relevant safety considerations. The discussion should also cover side effects, monitoring, time commitments, costs, and alternatives.
Ask how progress will be measured, when the plan will be reassessed, and what follow-up may be needed.
Our goal is to recommend care that has a purpose for you. Sometimes that means one treatment. Sometimes it means reconsidering the diagnosis or adjusting an existing plan before adding anything.
You should understand why each part of your treatment is being recommended—and what we still do not know.
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