rTMS vs Ketamine

When searching for options to treat your mental health, you may come across Ketamine assisted therapy.

This is a very different option for treatment in comparison to Transcranial Magnetic Stimulation (TMS). We thought it might be helpful to compare the two treatments.

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Comparison TMS vs Ketamine

How They Work

The exact mechanism by which Ketamine has an antidepressant effect, is not well understood. Ketamine can cause dissociative and psychedelic experiences, which have been suggested to bring about improvements in mental health.

TMS stimulates the nerve cells in the area of the brain which it targets. The magnetic pulses delivered can encourage or discourage neurons from firing, depending on the frequency of stimulation. In the treatment of depression, TMS stimulates neurons to fire, leading to improvements in mood, motivation, and concentration. In the treatment of anxiety, OCD and PTSD, TMS dampens down overactivity to bring about reductions in intrusive, obsessive and upsetting thoughts.

Over time, TMS returns neural activity to normal levels and encourages the nerve cells to form more connections and more efficient connections, with one another. It has also been shown to increase the levels of important neurotransmitters, such as dopamine and serotonin, available for use in the brain.

TMS Compared to Other Treatments

ketamine infusion blue


How it works

The exact mechanism by which Ketamine has an antidepressant effect, is not well understood. Yet it is understood that it can provide a dissociative and psychedelic experiences which are suggested to bring about improvements in mental health.


Depending on the route available, Ketamine can be considered invasive. If Ketamine is given as an infusion, it is provided via an intravenous line. Esketamine Nasal Sprays are given as a spray in the nostrils.

Treatment Indications/Approvals

Depression, Anxiety, PTSD, Addiction (all off label)


A randomised control trial, that included 41 patients with treatment resistant depression delivered 6 infusions of ketamine over 2 weeks. 59% of participants responded to the treatment (Phillips et al, 2019)

Side Effects

Dissociation/feeling of detachment, light headedness, nausea, increase in blood pressure (generally reverts after the session), unsettling thoughts or visual hallucinations which can be intolerable to some patients. (Walsh et al, 2022)

Treatment Duration

The duration of a Ketamine treatment session lasts around 2 hours. This is a period long enough for between the infusion of Ketamine and for the effects of it to wear off. Each patient will need an escort to drive them home after each session and accompany them during the Ketamine wearing off. Patients are not be able to drive until 24 hours after your infusion.

Sessions Required

Generally speaking for Ketamine treatment, 6-8 sessions are required over a 3-4 week period.

TMS Brain


How it works:

TMS stimulates the nerve cells in the area of the brain which it targets. The magnetic pulses delivered can encourage or discourage neurons from firing, depending on the frequency of stimulation. This is tailored to the condition that is being treated. For example, in depression TM encourages neuron activity whilst in Anxiety, OCD and PTSD, activity is dampened by TMS.


TMS is non-invasive. Whilst the patient is awake and relaxed, the magnetic coil is lightly placed on the area of the head that is being treated and magnetic pulses are given. Feeling much like a tapping sensation on the head.

Treatment Indications/Approvals

Depression (NICE 2015), Anxiety, PTSD, OCD (FDA 2018), Addiction, BPD, Insomnia (off label) .


61% of patients we have treated at Smart TMS for depression have responded to treatment, with 52% going into complete remission.

Side Effects

Mild headache, muscle twitching, scalp discomfort, rare risk of convulsion (Rossi et al, 2009)

Treatment Duration

TMS sessions generally last 30 minutes or less. You are safe to drive afterwards and can continue your day as normal.

Sessions Required

A full course of treatment is normally 30 sessions and can be completed in 2-6 weeks. Most patients can have multiple sessions in one day, depending on their condition.

Is TMS Treatment Right For You?

Try our quick 2 minute questionnaire to see whether TMS treatment could help.

Further reading

We have previously written a blog on the use of Ketamine in mental health treatment. Please check out here for more information.


More information – Ketamine vs TMS


Ketamine as a treatment is in its infancy, especially compared to TMS as it has only recently been made legal for use in clinical trials. Several randomized clinical trials on Ketamine Assisted Therapy (KAT) for a number of mental health conditions, has shown promising results in recent years.

However, Ketamine infusion is not currently approved by NICE (National Institute for Care and Excellence) or the Medicines and Healthcare Regulatory Agency, in the UK, as a treatment for mental health conditions. Esketamine nasal spray has been FDA (Food and Drug Administration) approved in the United States for treatment resistant depression since 2019, but Ketamine infusion has yet to receive FDA clearance.

TMS has been FDA approved in the United States, as a depression treatment since 2008. In the UK TMS has been approved by NICE since 2015. TMS has also been FDA approved in the United States for OCD since 2018.


The typical cost of Ketamine Infusion in London, UK, includes an Initial Consultation at around £745. Each infusion is around £595, with 6-8 infusions recommended. Therefore the total cost for infusion treatment alone is between: £4315 – £5505. This does not include therapy. (Saveminds.co.uk)

At Smart TMS our prices include a Clinical Assessment at £250, followed by a full course of treatment of 30 sessions at a total cost of between £6850 – £8250. This is dependent on the condition and clinic.

A number of clinics in the UK are now offering Ketamine treatment. Although most require a referral from a GP or psychiatrist.

Smart TMS has an extensive network of clinics across the UK & Ireland. Self-referral is accepted as well as GP and Psychiatrist referrals.


Ketamine treatment comes in different types, this includes Infusion, Esketamine Nasal Spray, Ketamine Assisted Therapy/Psychotherapy.

Whereas TMS is magnetic stimulation to the brain, delivered via a magnetic coil. The differences in treatment type include the frequency type and intermittent Thetaburst (iTBS).

  • Phillips, J. L., Norris, S., Talbot, J., Birmingham, M., Hatchard, T., Ortiz, A., … & Blier, P. (2019). Single, repeated, and maintenance ketamine infusions for treatment-resistant depression: a randomized controlled trial. American Journal of Psychiatry, 176(5), 401-409.
  • Rossi, S., Hallett, M., Rossini, P. M., Pascual-Leone, A., & Safety of TMS Consensus Group. (2009). Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical neurophysiology, 120(12), 2008-2039.
  • Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., … & Morgan, C. J. (2022). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych open, 8(1).
  • https://saveminds.co.uk/ketamine-cost/
  • https://www.smarttms.co.uk/pricing/