Depression treatment options in St. Louis, compared
This directory already publishes separate guides to therapy, medication, TMS, Spravato, and ketamine infusions. This page pulls the concrete facts out of those guides and lines them up side by side, so you can compare format, course length, FDA status, and insurance in one place instead of reading five pages back to back.
Format and course length
1. Talk therapy and counseling
Billed per session, with a copay if you have insurance or sliding-scale/out-of-pocket fees if you do not. Open-ended rather than a fixed course.
Source: Insurance & cost in Missouri
2. Psychiatric medication management
A visit copay plus the cost of the prescription; generic antidepressants are often inexpensive. Medications typically take a few weeks to show their full effect.
Source: Insurance & cost in Missouri
3. TMS (transcranial magnetic stimulation)
In-office sessions with no sedation; each session runs from a few minutes up to about forty minutes. Sessions are typically given five days a week over roughly four to six weeks, then tapered.
Source: TMS providers in St. Louis
4. Spravato (esketamine)
Self-administered nasal spray in a certified clinic, followed by about two hours of in-clinic monitoring before someone else drives you home. Early on, sessions are often twice a week, then taper based on response.
Source: Spravato providers in St. Louis
5. Ketamine infusions (off-label)
Delivered as an IV drip over roughly forty minutes with monitoring; typically given as a series of infusions rather than a single visit.
Source: Ketamine vs Spravato
FDA status
6. TMS is FDA-cleared
The U.S. Food and Drug Administration cleared TMS for depression in adults who have not gotten enough relief from antidepressant medication.
Source: TMS providers in St. Louis
7. Spravato is FDA-approved
The FDA approved esketamine (Spravato) in 2019 for adults with treatment-resistant depression, and later for depressive symptoms in adults with major depression who have suicidal thoughts.
Source: Spravato providers in St. Louis
8. Ketamine infusions are off-label for depression
IV ketamine has been used for decades as an anesthetic and is given off-label for depression, meaning the FDA has not approved that specific use even though many clinicians use it based on research and experience.
Source: Ketamine vs Spravato
Insurance and MO HealthNet
9. TMS and Spravato are the more commonly covered options
Many insurers, including Medicare and Medicaid plans, cover TMS for treatment-resistant depression when criteria are met. Spravato is covered by many plans for treatment-resistant depression, though it often requires prior authorization.
Source: Insurance & cost in Missouri
10. Ketamine infusions are frequently out of pocket
Because IV ketamine is off-label for depression, it is frequently not covered by insurance, so ketamine infusion clinics often charge out of pocket, and a series of infusions can add up.
Source: Ketamine vs Spravato
11. MO HealthNet covers behavioral health generally
MO HealthNet is Missouri's Medicaid program. It covers behavioral health services, and Missouri expanded eligibility so more low-income adults qualify. Not every clinic accepts it, so it is worth asking directly.
Source: Insurance & cost in Missouri
Getting home afterward
12. Driving restrictions differ by treatment
After TMS you can drive yourself home and return to normal activities right away, since no sedation is involved. After Spravato or a ketamine infusion, both require monitoring and you do not drive yourself; you arrange a ride for the rest of the day.
Source: TMS providers in St. Louis and Ketamine vs Spravato
The bottom line
None of these options is a cure, and none of them is right for everyone; a clinician who knows your history is the one who can actually weigh the trade-offs. What this comparison is meant to do is save you from reading five separate guides to answer one practical question: what does each option actually involve, and what would insurance likely do with it. For a deeper look at any one option, see the source guides linked above, or start with how to choose a provider.
Recommended local provider
TMS and Spravato under one roof
Brain Recovery Centers is a doctor-supervised clinic in the St. Louis / St. Charles County area offering both FDA-approved Spravato and FDA-cleared TMS for treatment-resistant depression and PTSD, and accepts most insurance including MO HealthNet. Based in St. Peters, the clinic serves both St. Charles County and St. Louis County, in person and by telemedicine.
Visit Brain Recovery CentersDisclosure: Brain Recovery Centers is a recommended partner of this directory. Confirm current services and eligibility with the clinic.