TMS vs Antidepressants

Finding effective depression treatment can be challenging, especially when cost and insurance coverage add to the stress. Fortunately, for individuals in Illinois, several advanced, insurance-backed options are available beyond traditional antidepressants and therapy. This article explores innovative treatments for depression that are available at our Albany Clinic in Carbondale. Addressing the Need for Affordable Depression Relief in Illinois Depression remains a significant public health concern in Illinois. In 2023, data showed that 18.1% of all adults in the state had a doctor's diagnosis of a depressive disorder . Traditional first-line treatments for depression include medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). However, these are not universally effective; approximately one-third of patients are treatment-resistant. Even when these medications do work, they often take a long time to produce noticeable improvements, and unpleasant side effects can deter their use. Talk therapies , such as cognitive behavioral therapy (CBT) and psychodynamic therapy, are also strongly recommended. These treatments can have hugely beneficial effects, but it can require a lot of time commitment for results to show. Moreover, not all therapists accept insurance–especially for those practicing more specialized forms–making the treatment inaccessible for many. Spravato (Esketamine) for Depression What is Spravato, and how does it work? Spravato is an FDA-approved nasal spray that contains esketamine, a derivative of ketamine. Like ketamine, esketamine treats depression by interacting with NMDA receptors , proteins that play a key role in learning and memory. This interaction triggers several neurological processes, including neuroplasticity —the strengthening and forming of connections between nerve cells. Enhanced plasticity may improve the function of nerve circuits responsible for mood regulation, increasing overall well-being. A typical Spravato treatment involves sessions administered under medical supervision, starting with twice-weekly doses and then tapering as appropriate. Whereas antidepressants typically take around four weeks to show an effect, Spravato can have rapid action at alleviating symptoms. A study found that Spravato significantly reduced depression symptoms compared to a placebo drug within just 24 hours of administration. Does Insurance cover Spravato? Due to its FDA approval, Spravato is covered by most major insurance plans in Illinois, including Medicare and Medicaid. However, only patients with a formal diagnosis of treatment-resistant depression (TRD) or major depressive disorder with suicidal ideation (MDSI) are eligible for the treatment. While the medication is usually covered by insurance, patients may still have out-of-pocket costs , including copays , deductibles , and pre-treatment medical evaluations . Your exact expenses will depend on your specific insurance plan. At the Albany Clinic, we’re here to help you understand your costs and maximize your coverage. Transcranial Magnetic Stimulation (TMS) Therapy What is TMS, and how does it work? TMS therapy is a noninvasive procedure that uses magnetic fields to stimulate underactive regions of the brain associated with mood regulation. In depression, TMS targets the dorsolateral prefrontal cortex (DLPFC) , which is often less active in individuals with the condition. TMS therapy works by: Inducing electrical activity in neurons , prompting the release of neurotransmitters involved in mood and motivation. Increasing the activity of neural circuits responsible for mood regulation. Enhancing neuroplasticity , potentially “re-wiring” nerve circuits associated with unhealthy thinking and behavior. The treatment protocol typically consists of daily sessions over several weeks. Each session lasts about 20-40 minutes, during which patients remain awake and alert. Does insurance cover TMS? Since TMS therapy is FDA-approved, some major insurance providers in Illinois cover costs, but unfortunately, the state’s Medicaid does not. If you're considering TMS, check with your insurance provider to see if your plan includes coverage, as eligibility and benefits vary. At the Albany Clinic, we're here to help clarify details and explore options to make treatment more affordable. IV Ketamine Infusion Therapy What is an IV ketamine infusion and how does it work? IV ketamine infusion therapy involves administering ketamine intravenously at sub-anesthetic doses . This approach has shown rapid and robust antidepressant effects, especially in individuals with treatment-resistant depression. IV ketamine shares the same mechanism as Spravato but tends to have more rapid-acting effects. A standard course includes multiple infusions over a set period, with each session lasting approximately one hour. Does insurance cover IV ketamine? Unlike Spravato and TMS, IV ketamine infusion therapy is not FDA-approved for depression treatment and instead is used “ off-label .” This means most insurance plans don’t accept ketamine, and coverage is limited. However, some insurance companies may reimburse some of the treatment costs, such as the evaluation and management part. At the Albany Clinic, we’ll provide you with all the documentation to submit a claim to your insurance provider, but full payment is required before each procedure. Navigating Insurance for Depression Treatment Understanding insurance coverage for depression treatments can be complex. Here are steps to help streamline the process: Verify Coverage : Contact your insurance provider to inquire about treatment coverage specifics. Some insurers require a history of treatment failures with traditional antidepressants before approving coverage for these advanced therapies. Obtain Pre-Authorization : Many insurers require pre-authorization for certain treatments. Ensure all necessary approvals are secured before initiating therapy. The Albany Clinic's administrative team can assist in submitting pre-authorization requests. Understand Financial Responsibilities : Clarify any co-pays, deductibles, or out-of-pocket expenses associated with your treatment plan. Consult Our Team : The Albany Clinic's administrative staff is experienced in navigating insurance processes and can assist you in understanding and managing the financial aspects of your treatment. We also provide financial counseling to help patients explore payment plans and reimbursement options. Going Forward Navigating insurance for depression treatment can be complex, but you don’t have to do it alone. At The Albany Clinic , we’re dedicated to helping patients access effective, insurance-backed treatments while minimizing out-of-pocket costs. Contact us today to learn more about your options and take the next step toward relief.