Refer a Patient

Why Refer to Us

Dr. Thunder has always taken the approach that pain is a multifaceted problem exacerbated by depression, anxiety, nonrestorative sleep, and a myriad of life experiences. Thunder Pain and Wellness has adopted targeted depression treatments over the last 10 years and become a regional leader in providing cutting edge treatments for treatment-resistant depression (TRD) and challenging-to-treat major depressive disorder (MDD).

Options and Experience

Our patients with TRD/MDD who've tried and failed at least 2 oral antidepressants have three treatment options under one roof -- IV ketamine, transcranial magnetic stimulation (TMS), and esketamine (SPRAVATO -- nasal ketamine). As the first clinic in the area to offer IV ketamine, we now have nearly a decade of experience treating patients with ketamine. Our practice was also among the first to adopt TMS and SPRAVATO, and we are of course REMS-certified. Patients appreciate our private treatment rooms and the safety and comfort we provide with our experienced staff.

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intake@thunderpain.com
(775) 336-6410

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SPRAVATO, TMS, And IV KETAMINE COMPARISONS

Categories Spravato TMS Ketamine
Mechanism of Action Esketamine, the S-enantiomer of ketamine, acts as an NMDA receptor antagonist, modulating glutamate neurotransmission. TMS uses electromagnetic pulses to stimulate specific brain regions, primarily the left dorsolateral prefrontal cortex (DLPFC). Ketamine, an NMDA receptor antagonist, affects glutamate transmission, potentially enhancing synaptic plasticity and alleviating depression and pain.
Administration Self-administered via nasal spray under medical supervision by REMS-certified prescriber. Monitored in-office for 120 minutes. Non-invasive treatment involves placing a magnetic coil on the scalp to deliver pulsed magnetic stimuli to the brain. Takes less than 30 minutes. Administered intravenously (IV) over 1 to 3.5 hours, depending on the condition being treated.
Treatment Schedule Twice weekly for the first 4 weeks, followed by once weekly for 4 weeks, followed by maintenance dosing. Five days a week for about 6 weeks. Variable, generally a series of 8 infusions for chronic pain and 4 infusions for depression.
Potential Candidates Patients with Major Depressive Disorder, single episode or recurrent, moderate to severe. Failure of 2+ oral antidepressants. Patients with Major Depressive Disorder, single episode or recurrent, moderate to severe. Failure of 2-3+ oral antidepressants. Participation in psychotherapy. Patients seeking viable alternatives to conventional treatments for depression, Complex Regional Pain Syndrome (CRPS), and other types of chronic pain.
Insurance Generally authorized by insurance; coverage and out-of-pocket expenses vary by plan. Generally authorized by insurance; coverage and out-of-pocket expenses vary by plan. Unlikely to be covered by insurance.
Side Effects Common side effects include dissociation, dizziness, nausea, sedation, anxiety, increased blood pressure, and feeling "drunk". Common side effects include headaches, scalp discomfort, lightheadedness, facial muscle twitches, tingling. Rarely (0.1%), TMS may trigger transient seizures. Common side effects include dissociation, dizziness, nausea, sedation, anxiety, increased blood pressure, and feeling "drunk".
Drive Self to/from Treatment No Yes No