If you’ve tried two or more antidepressants and still don’t feel like yourself, you’re not alone — and you’re not out of options. Treatment-resistant depression in Dubai is more common than many people realize, with global research suggesting that around a third of people with depression don’t respond fully to standard medication. The good news: newer treatments like TMS and Esketamine therapy are giving many of these patients real relief, often within days and weeks rather than months.
At Newcastle Dubai, our psychiatric specialists in Jumeirah work with patients who’ve often been on multiple medications without success. In this guide, we’ll explain what treatment-resistant depression actually means, how TMS and Esketamine therapy work, how they compare, and what to expect if you’re considering either option.
Table of Contents
- What Is Treatment-Resistant Depression?
- What Is TMS and How Does It Work?
- What Is Ketamine and Esketamine (Spravato) Therapy?
- TMS vs Medication: What’s the Difference?
- Benefits of Brain Stimulation Therapy
- What to Expect: The Treatment Process
- Why Choose Newcastle Dubai
- Frequently Asked Questions
- Key Takeaways
What Is Treatment-Resistant Depression?
In short: Treatment-resistant depression (TRD) is generally defined as depression that hasn’t improved after trying at least two different antidepressant medications at adequate doses for an adequate length of time.
This doesn’t mean nothing will work — it means it’s time to look beyond standard first-line medications. Research drawing on global health data estimates that roughly a third of people with major depressive disorder fall into this category. For these patients, options like esketamine (Spravato) (nose puffs), and transcranial magnetic stimulation (TMS) have become increasingly important parts of psychiatric care.
What Is TMS and How Does It Work?
Transcranial magnetic stimulation (TMS) is a non-invasive depression treatment that uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation — typically the left dorsolateral prefrontal cortex, an area often underactive in people with depression.
During a session, a coil is placed near your scalp, and short magnetic pulses are delivered in a painless, repetitive pattern. There’s no anaesthesia, no needles, and you remain fully awake — most people read, listen to music, or simply relax during the session. A typical course involves daily sessions over several weeks, though accelerated protocols can compress this into a shorter timeframe.
What Is Esketamine (Spravato) Therapy?
Previously Ketamine infusion therapy involved administering low, controlled doses of ketamine — a medication originally used as an anaesthetic — under close medical supervision. It works differently from traditional antidepressants, acting on the brain’s glutamate system rather than serotonin pathways, which is part of why it can produce rapid improvements in mood for some patients.
Spravato (esketamine) is the most advanced version given as a nasal spray, approved for use alongside an oral antidepressant in treatment-resistant depression. Clinical research has shown that ketamine-based treatments can produce a meaningful response in a substantial proportion of patients, often within hours to days — much faster than conventional antidepressants, which can take four to six weeks to show effects.
TMS, Esketamine and traditional Medications: What’s the Difference?
| Factor | Traditional Medication | Esketamone | TMS |
| Mechanism | Adjusts neurotransmitter levels (serotonin, etc.) | Works on the brain glutamate leading to rapid improvement in mood | Directly stimulates brain regions linked to mood |
| Onset of effect | Often 4–6 weeks | Often days to weeks | Often within 2–4 weeks of starting sessions |
| Side effects | Can include weight gain, sexual side effects, fatigue | Sleepiness, dizziness, transient disconnect from environment, nausea | Mild scalp discomfort or headache during early sessions |
| Invasiveness | Oral, systemic | Nasal puff, easy to administer and well tolerated | Non-invasive, localised |
| Best suited for | First-line treatment | Patients who haven’t responded or tolerated medication alone | Patients who haven’t responded to medication alone |
Many patients don’t have to choose one or the other — TMS and medication, or TMS and Esketamine therapy, are sometimes used together as part of a combined treatment plan, depending on individual response and clinical judgement. Our psychiatrists at Newcastle Dubai will advise you on best approach suitable to your needs.
Benefits of Brain Stimulation Therapy
- Non-invasive – no surgery, anaesthesia, or hospital stay required
- Drug-free option – useful for patients who experience medication side effects or interactions
- Targeted approach – stimulates specific brain regions linked to mood regulation
- Can be combined with ongoing therapy or medication
- Growing evidence base – increasingly supported by clinical research for TRD
As with any psychiatric treatment, individual results vary, and TMS isn’t guaranteed to work for everyone. A proper psychiatric assessment is the only way to know if it’s a suitable option for your situation.
What to Expect: The Treatment Process
- Initial psychiatric consultation – Reviewing your treatment history, current medications, and symptoms.
- Assessment for suitability – Determining whether TMS, Esketamine therapy, or another approach fits your case.
- Treatment planning – Establishing a session schedule and realistic expectations.
- Treatment sessions – TMS sessions typically last 20–40 minutes; Esketamine sessions are administered under supervision with monitoring for 2-3 hours. The number of sections are scheduled according to the personalized needs of each patient.
- Progress monitoring – Regular check-ins to track mood changes and adjust the plan as needed.
- Maintenance planning – Discussing follow-up sessions if needed to maintain improvements.
Why Choose Newcastle Dubai
Newcastle Dubai’s mental health clinic in Jumeirah brings together psychiatric specialists experienced in managing treatment-resistant depression, including patients who’ve already tried multiple medications without success. We take a thorough approach — starting with a full psychiatric consultation before recommending any treatment path, whether that’s TMS, Esketamine therapy (Spravato), or a combination approach.
Being based near Jumeirah Beach Road, we also offer the privacy and discretion many patients are looking for when seeking psychiatric care.
Frequently Asked Questions
What qualifies as treatment-resistant depression?
Generally, depression that hasn’t responded to at least two different antidepressants taken at proper doses for an adequate duration — though your psychiatrist will assess your specific history.
Is TMS painful?
Most people describe it as a tapping or knocking sensation on the scalp. Some experience mild discomfort or headache during the first few sessions, which usually decreases over time.
How many TMS sessions are typically needed?
A standard course often involves daily sessions, five days a week, over several weeks — though your psychiatrist will tailor this to your response.
Is Esketamine therapy safe?
When administered under medical supervision in a clinical setting, Esketamine therapy is considered very safe for most appropriate candidates, with monitoring throughout each session.
How quickly does Esketamine therapy work?
Some patients notice mood improvements within hours to days of their first session, though individual responses vary significantly.
Is Spravato the same as ketamine?
Spravato (esketamine) is related to ketamine but is a specific nasal spray formulation approved for use alongside an oral antidepressant for treatment-resistant depression. It is much easier to administer as there is no need for IV drips.Â
Can I stop my current antidepressant before starting TMS?
This decision should always be made with your prescribing psychiatrist — many patients continue medication alongside TMS.
Does TMS have lasting effects, or will symptoms return?
Response duration varies. Some patients maintain improvements for months, while others benefit from periodic maintenance sessions.
Is TMS or Esketamine therapy covered by insurance in the UAE?
Coverage varies by provider and policy. Our team can help you understand what documentation may be needed for your insurer.
How do I know if TMS vs medication is right for me?
This depends on your treatment history, symptom severity, and personal preferences — a full psychiatric assessment at Newcastle Dubai is the best starting point.
Key Takeaways
- Treatment-resistant depression affects roughly a third of people with major depressive disorder, according to global research.
- TMS is a non-invasive, drug-free option that stimulates specific brain regions linked to mood.
- Esketamine (Spravato) can produce rapid relief for some patients, often within hours to days and is much easier to give than standard intravenous infusion of Ketamine.
- TMS and Esketamine therapy can be used alone or as part of a combined treatment plan.
- A thorough psychiatric assessment is essential before starting any TRD treatment.
You Don’t Have to Keep Struggling Alone
If standard antidepressants haven’t worked for you, that doesn’t mean your options have run out. Book a confidential psychiatric consultation at Newcastle Dubai to discuss whether TMS, ketamine therapy, or another approach could be the right next step for you.