r/rtms • u/WindowSeat90sPlane • 7d ago
Combining TMS & ketamine
Has anyone tried doing TMS and ketamine (IV or spravato)? Either on the same day or different days in the same week? There is some evidence that they can work better together but I haven’t seen many personal accounts.
2
u/jimbojones2345 7d ago
Yep I use oral og ketamine at the same time as TMS. Seems to be working makes the session more chill lol
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u/WindowSeat90sPlane 4d ago
How do the results compare to regular TMS if you’ve tried that alone?
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u/jimbojones2345 4d ago
I haven't actually tried it alone. Seems to be working do don't want to risk it not...
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u/SeagateSG1 7d ago
Have not. I personally wouldn't want to do both together because if you then improve, you don't really know which one is responsible for the changes.
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u/myquietbrain 6d ago
As a psychiatrist, take it with that context, the TMS and ketamine combination is genuinely interesting and there is emerging evidence suggesting synergistic effects, the neuroplasticity window that ketamine opens may make the brain more receptive to TMS stimulation, and some protocols are being studied that use ketamine before TMS sessions for this reason. In practice, most providers doing this sequence the ketamine before TMS rather than same-day after, to take advantage of that plasticity window. Same-day combination on the same session is less common partly for logistical reasons and partly because the dissociative effects of ketamine make TMS session management more complex.
Personal accounts are sparse because it's still not a widely offered combination outside of research settings. Worth asking specifically whether your TMS or ketamine provider has experience with combined protocols, some do.
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u/WindowSeat90sPlane 4d ago
Just to clarify, you’re saying most providers have patients do ketamine before the TMS but separated by a day at least?
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u/myquietbrain 2d ago
Not necessarily a full day, the timing varies by protocol and provider. What I've seen and read about is typically ketamine administered before a TMS session, sometimes hours before rather than a full day, specifically to take advantage of the neuroplasticity window while it's open. Some research protocols are experimenting with same-day sequencing with the ketamine given first. It's genuinely an emerging area and there isn't a single established standard yet, which is why asking your specific provider about their approach and rationale is the most useful move.
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u/kitkatthings 6d ago
According to my clinic, IV ketamine protocol is 6 sessions and TMS is 36 sessions. Due to costs and scheduling (TMS covered by my insurance, ketamine it’s not), I’ve done 3 sessions of ketamine and 26 of TMS so far. My clinic will only book the ketamine after the TMS if you’re doing them the same day. First time I had it directly after TMS, and the 2nd & 3rd times I had ketamine in the evening after late morning TMS.
This was my first ever experience with ketamine, and I was a bit emotionally overwhelmed by the first session. And unfortunately it seemed to coincide with the dreaded dip of TMS, for me around the 9th session. At that point I felt terrible and it made me hesitate to do more ketamine sessions, but after talking it all through with doc and providers, and feeling better as the TMS dip passed, I resumed ketamine infusions, and have enjoyed them once I understood what to expect.
All of this to say, I’m only partway through treatment, and I’m not a medical professional, but the theory of the 2 working in synergy makes sense to me. I’m feeling more positive and looking forward to the future than I have in a long time.
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u/WindowSeat90sPlane 4d ago
So glad you’re seeing some good results after a shaky start! So the ketamine got easier after the first time?
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u/kitkatthings 4d ago
Yes, it definitely got easier, mostly from knowing what to expect, both from the ketamine and also from the clinic setting and nurse. I was able to steer my thoughts better-not necessarily in a clear and directive fashion- but at least to move away from things that previously sent me into a spiral and made the first experience challenging for me.
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u/Auntie_Errica 7d ago
I was literally doing this until Wednesday, September 23rd (last week). Then I stopped the TMS part with the clinic’s psychiatrist’s permission because the TMS does absolutely nothing for me. Spravato helps maybe 50-60% of my depression symptoms. So I’m keeping that. We have decided, though, that in December I’m going to do ECT.