## min read

Spravato Success Rate: Does It Work, and for Whom?

By

Sonia Garcia

|

October 26, 2026

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Spravato Success Rate: Does It Work, and for Whom?

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Spravato success rate figures are easy to find and hard to compare. In the trial that supported its FDA approval, 69.3% of people who finished 4 weeks of Spravato with a new antidepressant had responded, and 52.5% were in remission. A study of routine care in Italy found 64.2% response and 40.6% remission at 3 months. The numbers answer slightly different questions, but they agree on the essentials: Spravato helps many people with treatment-resistant depression, response is more common than remission, and no single percentage tells the whole story.

Spravato also leaves a real share of people without enough relief.

Spravato is the brand name for esketamine, a nasal spray FDA-approved for treatment-resistant depression: depression that hasn't responded adequately to at least two antidepressants, each given at a proper dose for long enough.

What "Success" Means: Response vs. Remission

Nearly every Spravato statistic comes from one yardstick, the Montgomery-Åsberg Depression Rating Scale (MADRS). It's a 10-item interview a clinician scores from 0 to 60, where higher means more severe, and people entering Spravato's main approval trial averaged about 37. Two thresholds turn that score into a success rate:

  • Response means the MADRS score has fallen by at least half from where it started.
  • Remission means the score has dropped to 12 or lower, the cutoff the Spravato trials used.

The distance between the two is wide. Someone who starts at 38 and falls to 19 counts as a responder and may still have symptoms that get in the way of work, sleep, or relationships. Remission is the fuller recovery and the harder bar, so every remission figure below sits under its response figure.

Spravato's Success Rate in the Trial Behind Its Approval

The short-term trial that supported FDA approval was TRANSFORM-2, published in The American Journal of Psychiatry in 2019. Researchers at 39 outpatient centers enrolled adults with moderate to severe depression who hadn't responded to at least two antidepressants in their current episode. Everyone switched to a new oral antidepressant. One group also received Spravato, 56 or 84 mg twice a week, and the other a placebo spray. Of 227 people randomized, 197 finished the 4-week double-blind phase, and MADRS scores in the Spravato group fell 4 points more, on average.

The European Medicines Agency's review of the trial data translates that into response and remission:

At day 28 Spravato + new antidepressant Placebo spray + new antidepressant
Response, people who completed 4 weeks 69.3% 52.0%
Remission, people who completed 4 weeks 52.5% 31.0%
Response, including people who left early 63.4% 49.5%
Remission, including people who left early 48.2% 30.3%

Look first at the comparison group: more than half of the people who started a new antidepressant with a placebo spray also responded. The trial's finding is the gap. Among people who completed 4 weeks, adding Spravato meant about 17 more responders and 21 more remitters in every 100.

The counting method matters too, and it explains much of the inconsistency online. Figures near 69% count only people who finished. Figures near 63% for response, or 48% for remission, carry forward the last score of everyone who stopped early.

Real-World Success Rates

Trials select their patients carefully and follow them for weeks. Routine care is messier, which is what makes REAL-ESK useful. That 2022 study, published in the Journal of Affective Disorders, reviewed the medical records of 116 people with treatment-resistant depression treated with Spravato at several Italian mental health services, with assessments at 1 and 3 months.

By 3 months, 64.2% had responded and 40.6% were in remission, and both rates had climbed sharply between the first month and the third. The authors called that later response one of the study's novel findings. They also found no difference in effectiveness between people with other psychiatric conditions and people without them.

Lining those numbers up against TRANSFORM-2 doesn't work cleanly. REAL-ESK had no placebo or comparison group, everyone knew they were receiving Spravato, ratings weren't checked for consistency across centers, and 3 months is a different finish line from 4 weeks. It's encouraging evidence from everyday practice, not a controlled measure of effect.

Who Spravato Is Approved and Studied For

Spravato has two FDA-approved uses, built on separate trials, according to its prescribing information:

  • Treatment-resistant depression in adults, on its own or with an oral antidepressant. The original 2019 approval required an oral antidepressant alongside it; standalone use was added in January 2025.
  • Depression with acute suicidal thoughts or behavior, in adults with major depressive disorder, given alongside an oral antidepressant to treat the depressive symptoms.

The second use came from trials of a different group: adults with moderate to severe depression and active suicidal thoughts with intent, all of whom began with an inpatient psychiatric stay and standard care, and 63% of whom had attempted suicide before. Those results shouldn't be mixed with the treatment-resistant depression results.

The label is explicit about one boundary. Spravato hasn't been shown to prevent suicide or to reduce suicidal thoughts or behavior, and it doesn't replace hospitalization when that's needed, even if someone feels better after the first dose. It isn't approved for children. If suicidal thoughts are part of what you're living with right now, care for suicidal thoughts comes first, and 988 answers calls and texts at any hour.

How Fast Results Typically Appear

Spravato's reputation for speed comes from the first day. In TRANSFORM-2, most of the difference from placebo was already visible at 24 hours, the label reports; both groups kept improving through day 28, and the gap held steady rather than widening. The monotherapy trial behind the 2025 approval showed an effect at about 24 hours that lasted through day 28. In the suicidal-thoughts trials, the difference appeared as early as 4 hours.

Early movement isn't the same as response. In TRANSFORM-2, only 7.9% of people on Spravato had a response that began by day 2 and held through day 28, compared with 4.6% on placebo spray, a difference that wasn't statistically significant in the EMA review. The label calls for judging benefit at the end of the 4-week induction phase, after which sessions drop from twice a week to weekly.

And as REAL-ESK suggests, for some people even 4 weeks is early.

What Affects Individual Success

Research points to a handful of factors linked to outcomes, none of them a forecast for any one person:

  • Time on treatment. Benefit is formally assessed after the 4-week induction phase, and in REAL-ESK, many responses and remissions arrived between the first and third month.
  • Continuing after a good response. In a maintenance study described in the label, people in stable remission who kept taking Spravato went significantly longer before relapsing than people switched to a placebo spray, and the same held for people in stable response.
  • Age. The evidence is weaker in older adults. In a separate short-term trial of adults 65 and older, response at day 28 was 27.0% with Spravato versus 13.3% with placebo spray, and the trial's main measure narrowly missed statistical significance, per the EMA review.
  • Other psychiatric conditions. REAL-ESK found people with additional psychiatric diagnoses did as well as people without them.
  • With or without an oral antidepressant. Spravato has shown benefit both ways, but no trial in the label compared the two head to head.

Limits and Risks

The same data show where Spravato falls short.

  • Many people don't reach remission. Nearly half of the people who completed TRANSFORM-2 on Spravato weren't in remission at day 28, and in REAL-ESK, about six in 10 weren't in remission at 3 months.
  • Not every trial was positive. Of the three short-term trials submitted for approval, only TRANSFORM-2 met its main goal. A fixed-dose trial in adults and the trial in older adults both fell short of statistical significance, according to the EMA review.
  • It carries a boxed warning for sedation, dissociation, breathing problems (respiratory depression), and misuse or abuse, plus the risk of suicidal thoughts and behaviors that antidepressants carry for children and young adults. Sedation showed up in 48% to 61% of trial participants on Spravato, and dissociation, a sense of detachment that can warp time, space, or surroundings, in 61% to 84%.

Those risks shape how Spravato is given. It's only available through a restricted program called the Spravato REMS. You use the spray yourself under supervision in a certified healthcare setting, your blood pressure is checked before and after, and you're monitored for at least 2 hours before you're cleared to leave. Driving is off-limits until the next day, after a night of restful sleep. People with certain blood vessel problems, including an aneurysm, an abnormal connection between arteries and veins, or past bleeding in the brain, can't take it at all.

Talking to a Psychiatrist About Your Options

A Spravato success rate is a group statistic. It shows that Spravato helps a substantial share of people with treatment-resistant depression and that remission is harder to reach than response. It can't tell you what will happen for you. That depends on your diagnosis, what you've tried and for how long, your medical history, and the rest of your care.

We don't offer Spravato at Amae. Major depressive disorder is among the conditions our clinics specialize in, and when it hasn't eased with medication, our psychiatrists treat it within our integrated care model, which puts psychiatry, medication management, therapy, and primary care on one team. TMS therapy runs at three of our clinics: Los Angeles, Los Altos, and San Mateo. Our comparison of TMS, ketamine, and Spravato and our look at TMS success rates lay out how those options differ. To go over your history with someone who can see all of it, schedule an evaluation with an Amae psychiatrist. Anyone in immediate danger should call 911.

Frequently Asked Questions

What is Spravato's success rate in clinical trials?

In TRANSFORM-2, the short-term trial behind FDA approval, 69.3% of people who completed 4 weeks of Spravato plus a new antidepressant responded and 52.5% reached remission, versus 52.0% and 31.0% with a placebo spray plus a new antidepressant. Counting people who left early, remission was 48.2% versus 30.3%.

Does Spravato work better in real-world use than in trials?

The figures look similar, but they can't be compared directly. REAL-ESK, a study of 116 people treated in routine care in Italy, found 64.2% response and 40.6% remission at 3 months, with no placebo group and a longer follow-up than the 4-week trials.

How fast does Spravato start working?

Average scores often pull ahead of placebo within 24 hours, and in trials of people with suicidal thoughts, within 4 hours. A lasting response that early is uncommon, so benefit is judged after the 4-week induction phase, and some people improve later still.

Does Spravato work for everyone?

No. In TRANSFORM-2, nearly a third of people who completed treatment didn't respond, and nearly half didn't reach remission. Two other short-term trials, including one in adults 65 and older, didn't reach statistical significance on their main measure.

What happens if Spravato doesn't work for me?

A psychiatrist looks at the whole picture again: the diagnosis, whether treatment ran long enough, other medications, and other conditions. Next steps might include a different medication strategy, adding or changing therapy, or another treatment for treatment-resistant depression, such as TMS or ECT.

Is Spravato's success rate different for suicidal depression versus treatment-resistant depression?

Yes, and the two shouldn't be blended. The suicidal-thoughts trials measured average score changes 24 hours after the first dose in hospitalized adults receiving standard care. Spravato lowered depression scores more than placebo, but it didn't improve a rating of suicidality more than placebo, and it hasn't been shown to reduce suicidal thoughts.

Citations

  1. Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. The American Journal of Psychiatry. 2019;176(6):428-438. https://pubmed.ncbi.nlm.nih.gov/31109201/ (Tier 1)
  2. European Medicines Agency. Spravato: EPAR public assessment report (EMA/614876/2019). 2019. https://www.ema.europa.eu/en/documents/assessment-report/spravato-epar-public-assessment-report_en.pdf (Tier 2, regulatory review)
  3. Martinotti G, Vita A, Fagiolini A, et al. Real-world experience of esketamine use to manage treatment-resistant depression: a multicentric study on safety and effectiveness (REAL-ESK study). Journal of Affective Disorders. 2022;319:646-654. https://pubmed.ncbi.nlm.nih.gov/36167246/ (Tier 1)
  4. U.S. Food and Drug Administration. SPRAVATO (esketamine) nasal spray prescribing information, revised April 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s019lbl.pdf (Tier 2)
  5. 988 Suicide and Crisis Lifeline. https://988lifeline.org (Tier 2)

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# min read

PHP vs IOP: Key Differences in Outpatient Mental Health Care

By

Sonia Garcia

|

November 20, 2025

When weekly therapy sessions feel insufficient but full-time hospitalization seems excessive, you're facing a common challenge in mental health care. Many individuals find themselves in this middle ground, needing more intensive support than traditional outpatient therapy provides, yet maintaining the ability to sleep at home and continue essential daily responsibilities. 

Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) bridge this critical gap, offering structured, comprehensive treatment while preserving your connection to home and community. Understanding the difference between PHP and IOP can help you make an informed decision about which level of care best matches your current needs and circumstances.

What is an Intensive Outpatient Program (IOP)?

An Intensive Outpatient Program represents a structured approach to mental health treatment. It allows you to maintain your daily life while receiving comprehensive therapeutic support. IOP typically involves attending therapy sessions three to five times per week, each lasting two to four hours, providing significantly more contact than weekly therapy while allowing you to return home each evening. Research on intensive outpatient formats shows that structured short-term IOPs can lead to measurable clinical improvement. For example, a three-week intensive outpatient program demonstrated significant symptom reduction that remained stable three months later.

The therapeutic approaches in IOP often include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), group therapy sessions, individual counseling, and sometimes family therapy sessions. These evidence-based treatments address various mental health conditions while building essential coping skills and emotional regulation techniques.

IOP works best for individuals who have:

  • A stable and supportive community
  • Moderate mental health symptoms that don't require 24-hour supervision
  • The ability to function independently between sessions
  • Motivation to actively participate in treatment
  • Some level of emotional stability and safety awareness
  • Previous treatment experience or step-down from higher levels of care

At facilities like Amae Health, IOPs are designed to provide flexibility while maintaining therapeutic intensity. It allows patients to continue working, attending school, or managing family responsibilities during treatment.

Requirements for Intensive Outpatient Program

Before enrolling in an IOP, specific criteria must typically be met to ensure this level of care matches your needs:

  • A formal mental health diagnosis requiring intensive treatment
  • Demonstrated ability to live safely without 24-hour supervision
  • Commitment to attend all scheduled therapy sessions consistently
  • Motivation and readiness to actively participate in group and individual therapy
  • Access to at least some external support system (family, friends, or community)
  • Stable housing situation and basic ability to care for daily needs
  • No immediate risk of harm to self or others that would require inpatient care

These requirements ensure that participants can benefit fully from the program's structure while maintaining their safety and progress in treatment.

What is a Partial Hospitalization Program (PHP)?

A Partial Hospitalization Program provides a more intensive level of care than IOP while remaining less restrictive than inpatient hospitalization. PHPs and IOPs serve different populations based on symptom severity and stability needs. PHP typically involves daily sessions lasting four to five hours, Monday through Friday, with comprehensive clinical oversight throughout the treatment day.

PHP programs offer robust clinical support, including regular psychiatrist visits, medication management, and multiple daily therapy sessions. Evidence shows that intensive day-treatment settings can produce measurable clinical improvement in a short time frame. For example, a 2022 study of a family-based PHP reported significant positive change within the first five weeks of treatment, including faster symptom stabilization (Van Huysse et al., 2022).

This level of care is designed for individuals who require significant stabilization and support but can safely return home each evening with the appropriate support systems in place.

PHP is most appropriate for people who need:

  • Daily clinical monitoring and psychiatric oversight
  • Intensive symptom stabilization while maintaining some independence
  • Step-down care from inpatient psychiatric hospitalization
  • More structure than traditional outpatient or IOP can provide
  • Comprehensive medication management and adjustment
  • Crisis intervention skills and intensive coping strategy development
  • Preparation for successful transition to lower levels of care

The comprehensive nature of PHP makes it an excellent bridge between inpatient hospitalization and less intensive outpatient services.

Requirements for Partial Hospitalization Program

PHP admission typically requires meeting specific clinical criteria that indicate this intensive level of care is appropriate:

  • Diagnosis of moderate to severe mental health symptoms requiring daily intervention
  • Need for frequent clinical oversight and psychiatric monitoring
  • Ability to return safely to the home environment each evening
  • Readiness to engage in intensive, full-day therapeutic programming
  • Stable enough to participate in group settings without disrupting treatment
  • Access to support for daily attendance
  • Not requiring 24-hour medical or psychiatric supervision
  • Commitment to participating in comprehensive treatment planning

These criteria help ensure that PHP participants receive the appropriate level of care while maintaining the benefits of returning home each night.

PHP vs IOP: What Are the Main Differences?

Understanding the difference between PHP and IOP requires examining several key factors that influence treatment effectiveness and appropriateness:

Aspect PHP IOP
Intensity & Time Commitment Daily sessions, 4–5 hours per day, 5 days per week 3–5 days per week, 2–4 hours per session
Level of Clinical Support Frequent psychiatric oversight, medical management Primarily therapy-focused with periodic psychiatric consultation
Structure & Flexibility Highly structured daily schedule, limited flexibility for outside commitments More flexible scheduling, better work/family balance possible
Cost & Insurance Coverage Higher daily cost but often covered by insurance when medically necessary Lower cost per session, typically covered by most insurance plans
Treatment Team Size Larger multidisciplinary team including psychiatrists and therapists Smaller team focused primarily on therapeutic interventions
Medication Management Frequent medication monitoring and adjustment capabilities Periodic medication reviews with less frequent adjustments
Crisis Intervention On-site crisis support and intervention On-site crisis support and intervention

Which Program is Right for You?

Choosing between PHPs and IOPs depends on several personal and clinical factors that should be carefully evaluated with a mental health professional. Consider your current symptom severity and how it impacts your daily functioning. If you're experiencing significant mood instability, frequent crisis episodes, or need medication adjustments, PHP might provide the necessary intensive support.

Evaluate your home environment and support system. A stable, supportive home environment is crucial for both programs; however, PHP requires more significant support, as you'll be in treatment for most of each day. Consider your ability to consistently manage daily tasks, such as transportation, meals, and basic self-care.

Your current level of functioning at work, school, or in family responsibilities also influences this decision. IOP offers more flexibility for maintaining these commitments, while PHP requires a temporary reduction in outside responsibilities to focus intensively on treatment.

Amae Health's clinical team can help assess these factors through a comprehensive evaluation, ensuring you receive the most appropriate level of care for your current needs and circumstances.

Questions to Ask Before Choosing PHP or IOP

Before making your decision, consider asking these essential questions to ensure you understand what each program offers:

  • "How often will I meet with a psychiatrist for medication management and monitoring?"
  • "What specific types of therapy are included, and how do group and individual sessions balance?"
  • "Does my insurance plan cover both PHP and IOP options, and what are my out-of-pocket costs?"
  • "How flexible is the scheduling if I have work, school, or family commitments that cannot be changed?"
  • "What happens if my symptoms worsen or improve significantly during treatment?"
  • "How does the program handle crises, and what after-hours support is available?"

These questions help clarify practical considerations while ensuring the program aligns with your treatment goals and life circumstances.

Integrated Care at Amae Health

At Amae Health, we offer both PHP and IOP services across multiple locations, including Los Angeles, New York City, and Raleigh, providing accessible care when and where you need it. Our integrated approach combines evidence-based therapy, comprehensive medication management, and family support services to address all aspects of mental health recovery.

Our multidisciplinary teams understand that the difference between PHP and IOP isn't just about intensity — it's about matching the right level of care to your unique situation and recovery goals. Whether you need the daily structure of PHP or the flexibility of IOP, our clinicians work collaboratively to ensure seamless transitions between levels of care as your needs change.

We accept most major insurance plans and provide thorough insurance verification to help you understand your coverage options for both PHP vs IOP programs. Our commitment extends beyond symptom management to helping you develop long-term wellness strategies and resilience skills.

Ready to explore which program might be right for you? Visit our program pages to learn more about our PHP and IOP offerings, or contact Amae Health today to schedule a comprehensive assessment and take the first step toward effective, personalized mental health care.

# min read

TMS vs Medication: Comparing Depression Treatments

By

Sonia Garcia

|

September 23, 2026

Most people comparing TMS vs medication for depression arrive at the question the same way: the antidepressants have not brought enough relief. If that is you, it helps to know that both are evidence-based, FDA-cleared treatments, and they work in completely different ways. Medication adjusts brain chemistry from the inside. TMS stimulates the brain directly with magnetic pulses. Neither is universally better. The right choice depends on your treatment history, the severity of your symptoms, how you tolerate side effects, and your own preferences, especially once you are dealing with treatment-resistant depression or trying to figure out what to do when antidepressants don't work. This article compares the two fairly, not to push one over the other.

How Antidepressants Work

Antidepressants change the availability of certain brain chemicals, mainly serotonin and norepinephrine, that influence mood. The most common are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). Both are considered first-line treatment, meaning they are usually where a clinician starts.

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They are taken daily as a pill at home, and they work gradually. Most people need several weeks before the full effect shows, which is one of the harder parts of starting an antidepressant: you often have to wait to know whether it is working. Finding the right medication and dose regularly takes some trial and adjustment, and a first medication that does not help does not mean none will. There are many options within each class, so a clinician can switch or fine-tune based on how a person responds. Older tricyclic antidepressants (TCAs) also work but tend to cause harsher side effects, so they are usually reserved for later steps rather than first-line use. The main appeal of medication is convenience and evidence: it is taken at home, it is inexpensive, and it has decades of research behind it.

How TMS Works

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses focused magnetic pulses, similar in strength to an MRI, to stimulate the mood-regulating areas of the brain that tend to be underactive in depression, mainly the left dorsolateral prefrontal cortex. It is FDA-cleared for major depressive disorder in adults, and also for OCD (NIMH, Brain Stimulation Therapies).

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TMS is not electroconvulsive therapy (ECT). There is no anesthesia and no sedation, and the patient stays fully awake through each session, then drives home and returns to normal activity. During a session, a coil rests against the scalp and delivers pulses in short cycles, which most people feel as a tapping sensation. A typical course runs about five days a week for several weeks, with each session lasting under an hour, and the benefit tends to build gradually across the course rather than after any single visit.

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As a non-drug option, TMS is one of the main alternatives to antidepressants for people whose medication has stopped short. It usually works best as part of a broader treatment plan, coordinated with therapy and, in many cases, ongoing medication, rather than as a replacement for all other care.

TMS vs Medication: Side-by-Side Comparison

The two treatments differ on almost every practical dimension, from how they are delivered to how quickly they work and what they ask of you day to day. The table below lays the key differences side by side, and the sections that follow unpack the two that matter most to people making this decision: side effects and success rates.

Factor Antidepressants TMS
How it works Adjusts brain chemistry (daily medication) Magnetic pulses stimulate mood-regulating brain areas
Schedule Daily pill, at home In-clinic sessions, about 5 days a week for several weeks
Onset Several weeks Often within a few weeks of the course
Common side effects Weight change, sexual dysfunction, fatigue, sleep changes Mild scalp discomfort or headache, usually fades after the first week
Effect on memory or cognition Varies by medication No known negative effect on memory or cognition
Best positioned for First-line, mild to moderate depression When medication has not worked or side effects are intolerable

Side Effects Compared

Antidepressant side effects vary by class. SSRIs commonly cause weight gain and sexual dysfunction, though some effects ease after the first few weeks. SNRIs have a similar profile that is often milder. TCAs tend to be harsher, which is why they are rarely a first choice. These are systemic effects, because the medication acts throughout the body.

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TMS side effects are usually mild and short-lived: scalp discomfort, headache, or lightheadedness that typically passes soon after a session and lessens over the first week. The most serious risk, seizure, is very rare. Because TMS is non-invasive and targeted rather than systemic, it avoids the weight, sexual, and sleep side effects associated with medication, and it does not affect memory or cognition the way some people fear based on older brain treatments like ECT.

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It is not side-effect-free, though, and its main practical downside is different in kind. Instead of a daily side effect, TMS asks for a time commitment: traveling to a clinic most weekdays for several weeks. For someone with a demanding schedule or limited transportation, that logistical cost is real and worth weighing against the appeal of avoiding medication side effects. Neither profile is automatically easier to live with; they are simply different, and which one fits depends on the person.

Success Rates: What the Research Shows

Both treatments help many people, and neither helps everyone. Reading the numbers honestly matters more than cheerleading for either one. Two terms come up often: response means a meaningful reduction in symptoms, usually cutting them roughly in half, while remission means symptoms largely resolve. Remission is the higher bar and the real goal.

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For medication, the landmark STAR*D study found that roughly a third of patients reached remission on their first SSRI (Trivedi et al., American Journal of Psychiatry, 2006). That is a genuinely useful result for many people. But it also means most did not remit on the first try, and STAR*D showed that with each additional medication tried after a failure, the odds of remission tend to drop while side-effect burden tends to rise. That diminishing return is exactly the situation that leads people to look at other options.

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For TMS, a large real-world registry of more than 5,000 patients found that most experienced measurable improvement, with response rates ranging from about 58% to 83% and remission from about 28% to 62%, depending on how outcomes were measured (Sackeim et al., Journal of Affective Disorders, 2020). The wide ranges are worth noting: they reflect different rating scales and patient groups, and many of those patients were also taking medication, so the numbers describe TMS in real-world use rather than in isolation.

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For treatment-resistant depression specifically, a 2024 randomized trial compared TMS with switching or augmenting medication in 89 people who had not responded to at least two antidepressants, with both groups also receiving psychotherapy. The TMS group had significantly higher response and remission rates than the medication group (Dalhuisen et al., American Journal of Psychiatry, 2024). It is one of the clearest head-to-head comparisons available, though individual results always vary, and these figures describe groups, not guarantees for any one person.

When Antidepressants Don't Work: Where TMS Fits

About a third of people with major depressive disorder do not respond adequately to first-line treatment, a pattern clinicians call treatment-resistant depression. It is not a sign of personal failure or a rare edge case; it is common, and it has its own growing set of treatment options. When two or more medications have failed, or when side effects are intolerable, TMS becomes a well-supported next step, and the 2024 trial above is part of why it is increasingly positioned early in the treatment-resistant pathway rather than as a last resort.

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TMS is not the only option at this stage. Spravato (esketamine), a nasal spray derived from ketamine, is FDA-approved for treatment-resistant depression when used together with an oral antidepressant. It is given in a certified clinic under medical supervision, with monitoring after each dose, because of its dissociative effects. Combining TMS with an antidepressant is another route, and research suggests the combination can improve outcomes over medication alone. The larger point is that once first-line medication falls short, the path forward branches into several evidence-based options, and those branches are not mutually exclusive. A person might use medication and TMS together, or move from one approach to another as their psychiatrist learns what their brain responds to.

Who Is Each Treatment For?

Medication is often the right starting point for someone who is:

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  • Early in treatment for depression
  • Managing mild to moderate symptoms
  • Looking to avoid in-clinic visits
  • Someone who has responded well to an antidepressant before

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TMS is generally considered for someone who:

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  • Has tried multiple antidepressants without adequate relief
  • Cannot tolerate medication side effects
  • Prefers a non-drug approach
  • Has treatment-resistant depression

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Many people use both at different points, and some use them together. Where a person lands is a clinical decision, not a solo consumer choice, and it belongs with a psychiatrist who knows the full history.

Making the Decision With a Psychiatrist

TMS, medication, Spravato, and therapy are not competing products. They are tools a psychiatrist combines and adjusts based on diagnosis, history, and how a person responds over time. Comparing TMS and medication on paper is useful, but the decision is rarely either-or, and it is rarely one-and-done. It usually looks more like a sequence: start somewhere reasonable, measure the response, and adjust. The most reliable way to navigate that sequence, and to change course when needed, is a thorough evaluation within an integrated care setting, where the clinician managing your medication is the same one weighing whether TMS or another option fits.

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That is how care works at Amae Health. Our psychiatry-led teams evaluate the whole picture and coordinate treatment across medication, therapy, and procedures like TMS, which we offer at our Los Angeles clinic. You can explore our full range of treatments or, for severe depression that needs more structure, our Partial Hospitalization Program. Our resources for patients and families explain how integrated care works, and you can contact our team to ask about an evaluation.

Frequently Asked Questions

Is TMS better than medication for depression? Neither is universally better. Medication is first-line and works well for many people. For treatment-resistant depression, where two or more medications have failed, TMS often outperforms a medication switch. The right choice depends on history, severity, and side-effect tolerance.

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Can you do TMS and take antidepressants at the same time? Yes. TMS can be combined with antidepressants, and research suggests the combination can improve outcomes compared with medication alone. This should be coordinated by a psychiatrist.

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What are the side effects of TMS vs medication? TMS side effects are usually mild and short-lived, mainly scalp discomfort or headache that fades after the first week. Medication side effects vary but can include weight change, sexual dysfunction, and fatigue. Because it is non-invasive, TMS avoids the systemic side effects of medication.

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Does TMS work when antidepressants don't? Often, yes. TMS is specifically supported for treatment-resistant depression. A 2024 randomized trial found higher response and remission rates with TMS than with switching medications after failed trials. Individual results vary.

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How long does TMS treatment take? A typical course is sessions about five days a week for several weeks, each lasting under an hour. Antidepressants, by contrast, are taken daily and may take several weeks to show their full effect.

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What if neither TMS nor medication works? Other options exist, including Spravato (esketamine) used with an oral antidepressant, combination approaches, and structured programs like IOP or PHP for severe depression. A psychiatrist can help identify next steps. Depression is hard, and support is available: if you are struggling, call or text the 988 Suicide and Crisis Lifeline at 988, anytime.

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Citations

  1. Trivedi MH, Rush AJ, Wisniewski SR, et al. "Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D." American Journal of Psychiatry, 2006. psychiatryonline.org. Tier 1 (peer-reviewed).
  2. Sackeim HA, Aaronson ST, Carpenter LL, et al. "Clinical outcomes in a large registry of patients with major depressive disorder treated with transcranial magnetic stimulation." Journal of Affective Disorders, 2020. sciencedirect.com. Tier 1 (peer-reviewed).
  3. Dalhuisen I, van Oostrom I, Spijker J, et al. "rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches." American Journal of Psychiatry, 2024. PubMed 39108161. Tier 1 (peer-reviewed RCT).
  4. National Institute of Mental Health, "Brain Stimulation Therapies." nimh.nih.gov. Tier 2 (U.S. government).

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Further reading (external resources): NIMH, Depression; Mayo Clinic, Transcranial Magnetic Stimulation.

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# min read

15 Affirmations for Anxiety: How Positive Thinking Can Bring Calm

By

Sonia Garcia

|

October 31, 2025

In a world increasingly defined by stress and uncertainty, anxiety now impacts millions globally. Positive affirmations, a scientifically proven method of dealing with anxiety, are becoming increasingly popular. This simple but powerful self-help tool can transform our thinking and emotional state.

Affirmations for anxiety work by appealing directly to our subconscious mind. They gradually reorganize negative thinking patterns into more constructive and supportive ones. Regular practice of positive affirmations helps build a strong foundation of emotional stability and inner peace.

This article explores 15 powerful affirmations designed to help you manage distressing thoughts and emotions. You’ll discover how to use them effectively, understand the science behind why they work, and learn how to personalize them for the greatest impact.

How Affirmations Help Manage Anxiety

Affirmations are positive statements that we consciously repeat to change our thinking and emotional state. Negative thoughts can increase anxiety, but positive affirmations can create a protective barrier against anxious states. This means that you will be able to build a healthier attitude towards life situations.

The importance of affirmations lies in their ability to influence our subconscious mind directly. When we regularly practice affirmation anxiety, we are reprogramming our brains. We create new neural connections that support a more calm and balanced mind.

Let's take a detailed look at exactly how affirmations help with anxiety. Why not explore the scientific basis for their effectiveness and break down the specific mechanisms of their effect on our minds? This understanding will be essential for successfully applying affirmations in your anti-anxiety practice.

Understanding Anxiety’s Impact on the Mind

Anxiety has a profound effect on our emotions, our way of thinking, and our daily life. When we are anxious, our brain operates in a constant state of alertness to danger. Affirmations for anxiety help to reduce this tension and restore emotional balance.

An anxious state often manifests itself through excessive brooding. We start endlessly running through various scenarios in our heads. Worrying about the future becomes a constant backdrop to our lives, and fear of the unknown paralyzes our ability to act.

The Science Behind Positive Affirmations

Affirmations work at the level of our brain's neural connections. Through neuroplasticity - the brain's ability to form new neural pathways - the regular repetition of positive affirmations creates new thinking patterns.

Cognitive reframing, which is at the heart of affirmation anxiety, allows us to reframe anxious situations. By changing negative thoughts into positive affirmations, we gradually reduce our overall level of anxiety.

How to Use Affirmations for Maximum Effect

Daily Practices for Effective Affirmation Use

Incorporating positive affirmations into your daily life requires a systematic approach. Start your morning with 5-10 minutes of meditation. Breathe smoothly, remaining completely calm, and repeat the chosen affirmations. Keeping a journal will help you track your emotions and progress.

Personalizing Affirmations for Your Needs

Every person is unique, and their experience of anxiety is different, too. Adapt affirmations for anxiety to your specific fears and experiences. Use words and images that resonate with you.

15 Positive Affirmations to Alleviate Anxiety

I Am Safe and Secure

This affirmation helps to reduce fear-based thoughts. By reminding ourselves of our safety, we create a strong psychological anchor. Our brain begins to perceive the world around us as less threatening.

I Trust Myself to Handle Whatever Comes My Way

Self-confidence is the key to overcoming anxiety. This affirmation of anxiety strengthens inner resilience and helps us to be more calm about the uncertainty of the future.

I Am in Control of My Thoughts and Emotions

Realizing that emotions are a natural part of our lives is essential. At the same time, we can control our thoughts and reactions to what happens. Positive affirmations help to reinforce this realization.

I Breathe in Calmness and Breathe Out Stress

Combining this affirmation with deep breathing creates a powerful tool for instant relaxation. Visualize being filled with calmness with each inhale and released from tension with the exhale.

I Am Worthy of Peace and Happiness

Everyone deserves emotional well-being. This affirmation builds self-esteem and helps you accept your right to happiness and peace of mind.

I Let Go of Fear and Embrace Inner Peace

Practicing letting go of intrusive anxious thoughts takes time and patience. Affirmations for anxiety help make the process more conscious and effective.

I Choose to Be Present in This Moment

Being consciously present in the moment is the antidote to anxiety about the future. This affirmation reminds us of the importance of living here and now.

I Have the Strength to Overcome Anxiety

Recognizing our ability to cope builds self-confidence. Each time we repeat this affirmation, we become stronger.

I Am Surrounded by Love and Support

You don't have to go through anxiety alone. This affirmation reminds us of the importance of accepting help from loved ones and seeking professional support.

I Choose to Focus on What I Can Control

Shifting your focus from uncertainty to action helps reduce anxiety. Concentrating on what is in our power gives a sense of control.

I Am Grateful for the Good in My Life

Practicing gratitude is effective in counteracting anxious thoughts. We create a positive counterbalance to negativity by finding reasons to be grateful.

I Am Becoming More Relaxed Every Day

Managing anxiety is a process of gradual improvement. This affirmation anxiety maintains faith in positive change.

I Treat Myself with Kindness and Compassion

Self-acceptance and patience are essential elements of recovery. Be kind to yourself on your journey of overcoming anxiety.

I Welcome Change and See It as Growth

Change often causes anxiety, but it also creates growth opportunities. This affirmation helps you see the potential for growth in change.

I Deserve to Feel Calm and at Peace

The closing affirmation affirms our right to emotional balance. Calm and peacefulness is the natural state we deserve.

Tips for Maximizing the Benefits of Affirmations

Consistency is Key

Regular practice of positive affirmations amplifies their impact. Daily repetition creates lasting neural connections and new patterns of thinking.

Combining Affirmations with Other Anxiety-Reduction Techniques

Affirmations for anxiety work more effectively when combined with other techniques. Complement them with deep breathing, meditation, or professional psychotherapy. Clinics like Amae Health combine evidence-based therapy with mindfulness practices and cognitive-behavioral tools to help patients manage anxiety at its root cause.

Conclusion

Positive affirmations are an effective tool for managing anxiety and restoring emotional balance. Practicing these affirmations with other techniques will help create a more peaceful and harmonious life. Remember that every step to calmness matters, even if the changes are gradual.

Remember, you don’t have to manage anxiety alone. Book a consultation with Amae Health and discover compassionate, evidence-based care designed to help you regain calm, confidence, and emotional balance.