I Don’t Want a Psychedelic‑Like Experience: Your Options With TMS and Medications

It’s completely valid to want treatment that keeps you fully alert, without the perceptual changes that can accompany ketamine therapy or esketamine (Spravato). Many patients tell Lumin Health, “I’m curious about results, but I’m really averse to altered experience.” If that’s you, there are compelling options that do not involve perceptual shifts. 

Options that keep you fully alert

Transcranial Magnetic Stimulation (TMS)

• What sessions feel like: You sit upright while a coil delivers magnetic pulses to a targeted brain region. Expect tapping on the scalp and brief twitches in facial muscles. No change in consciousness. Many patients read or listen to music.
• Cadence: Commonly five days per week for 6–9 weeks during the acute phase, with possible taper or maintenance later.
• Coverage and access: Often covered when criteria are met, and you can drive yourself to and from visits.
• Who it fits: People who prefer no perceptual changes, can attend frequent short visits, and want a non‑sedating option.

Medication strategies (augmentation)

• What this means: Adding a second medicine to an antidepressant when results are partial. Common options include aripiprazole, cariprazine, or lithium - there are many others out there.
• Cadence and monitoring: Daily at‑home medication with dose changes as needed. Expect check‑ins for side effects and, especially for lithium, periodic labs.
• Who it fits: Patients who prefer at‑home care without clinic observation and who are comfortable waiting weeks to see benefits.

A note on ECT

• Electroconvulsive therapy (ECT) happens under anesthesia, so there is no subjective experience of the procedure, but there is a component of experiential impairment. It is considered for severe or urgent presentations or people who are interested in a treatment that returns the greatest likelihood of success, and remains one of the most effective options in those circumstances, despite the (unfounded) stigma surrounding it. Recovery plans and cognitive side effects are reviewed in detail by experts before starting.

Comparing timelines and day‑to‑day life between TMS, medications, and ketamine therapy 

How long until change?

• TMS: improvements often build across weeks, but is seen to be quite durable. Some notice shifts earlier; others closer to the end of the acute course.
• Medications: augmentation typically takes days to weeks to show benefit after dose adjustments.

Daily realities

• TMS: short visits on weekdays, no driving limits, predictable routine.
• Medications: no clinic time beyond brief follow‑ups, but side effects may persist.

What you’ll plan for

• TMS appointments or pharmacy pickups, simple sleep and routine supports, and steady follow‑through. Many patients create and appreciate a written plan with week‑by‑week targets.
  
  

Efficacy, durability, and maintenance

• TMS: Some patients respond and maintain gains with occasional boosters, while others need a repeat course of the initial phase. Psychotherapy or behavioral support can help translate gains into daily routines, but is not required.
  
  
• Medications: When augmentation helps, you stay on it while monitoring for side effects. If relief fades, prescribers adjust dose or consider alternatives.

The most important signal is the pattern across weeks instead of the observed experience of a single day: look out for steadier sleep, more reliable energy, and re‑engagement with people and activities that matter to you.

If you’re still curious about ketamine treatment later

If at some point you want to learn what ketamine therapy entails, these are the basics:

• Esketamine (Spravato) is an FDA‑approved intranasal option for treatment‑resistant depression. Spravato treatment occurs only in a certified Spravato site, with medical monitoring and a ~2 hour commitment to be present. Because transient perceptual changes are common during dosing, you’ll need to arrange a ride home and should not drive until the next day.
  
  
• Off‑label ketamine is intramuscular ketamine injections at Lumin Health. As a result of the off-label use, coverage varies. Driving restrictions also apply.
  
  
• Success with ketamine and esketamine happens more predictably, more reliably, and more quickly than with TMS or augmenting medications.
  
  

If you ever consider ketamine for depression, Lumin Health would be glad to pace education and preparation to match your comfort.

To be clear: choosing not to pursue ketamine therapy due to trepidation regarding the altered experience is a valid decision. TMS, medications, and ECT remain evidence-based paths towards relieving depressive symptoms. 

A simple decision map for experiential ketamine therapy 

1. I do not want any altered experience.
   → Start with TMS or a structured medication plan. Set week 4 and week 8 checkpoints with your existing care team to assess progress towards your goals and reassess if you are feeling good or not yet.
   
   
2. I want a clinic‑based option without anesthesia and without perceptual shifts.
   → TMS is the best first fit. Keep psychotherapy optional but available if you want skills support.
   
   
3. If my values change later, I might consider ketamine treatment.
   → Bookmark information about Spravato treatment and off‑label routes, and talk with your clinician when you’re ready.
   
   

Psychotherapy without ketamine therapy

You can pair therapy with TMS or medications in a way that stays humane and steady:

• Behavioral activation: schedule one or two values‑based activities each week.
• Cognitive skills: identify one thought trap and test a more helpful alternative.
• Sleep supports: fixed wake time, a brief wind‑down, and stimulus control for insomnia.
• Exposure work (when relevant): pre‑planned small steps toward avoided situations.
  
  

If you ever choose ketamine treatment in the future, short sessions 24–72 hours after dosing may help you use the neuroplasticity window. 

FAQs

Can I get good results without ketamine therapy?
Yes. Many patients improve with TMS, ECT, or medication strategies. Ketamine therapy has been shown to provide relief from depression, but if it’s not the right fit for you at this time, we encourage you to try other interventions that may better align. 

How fast does TMS work compared with another medication?
TMS changes often build across weeks with weekday sessions, and new or augmented medications usually take days to weeks after dose changes. Ketamine therapy can relieve symptoms within hours or days from dosing. 

Will I be able to drive after TMS sessions?
Yes. TMS does not change consciousness and most people drive themselves to and from visits.

If I change my mind, could I try Spravato treatment later?
Yes. Spravato treatment is available if you decide to explore ketamine for depression later. You’ll need a ride home on dosing days.

Do I need psychotherapy with TMS or meds?
It’s optional. Many patients find skills‑based psychotherapy or brief behavioral support helpful for durability. The plan is yours.

Is off‑label ketamine the same as Spravato?
They are related but not the same. Spravato is FDA‑approved and delivered at Lumin Health under observation. Off‑label ketamine is delivered as intramuscular injections under analogous supervision. 

Choosing a mental health treatment path that fits your preference

Preferring to stay fully alert during mental health treatment is a sound, values‑based choice. TMS and medication strategies offer clear, evidence‑aligned paths without a psychedelic‑like experience. 

If your priorities shift later, you can learn about ketamine treatment, including Spravato, and decide then. Lumin Health can coordinate care with outside care partners and would be grateful to provide education about ketamine therapy at your pace.

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