Advanced TMS therapy and SPRAVATO® treatment for depression in Waco, Texas.
TMS Waco offers FDA-cleared transcranial magnetic stimulation (TMS) and FDA-approved SPRAVATO® (esketamine) nasal spray in a calm clinical setting in downtown Waco, under the direct supervision of Katherine Tharp, MD of Balance Psychiatry & Wellness.
Real-world outcomes from TMS therapy.
Outcomes from peer-reviewed clinical trials, meta-analyses, and multi-site outcomes data in adults with treatment-resistant Major Depressive Disorder treated with FDA-cleared rTMS protocols. Many of these patients had not responded adequately to one or more antidepressant medications prior to TMS.
A focused magnetic field, nothing more.
Transcranial magnetic stimulation (TMS) is an FDA-cleared, non-invasive treatment that uses focused magnetic pulses to activate the brain regions associated with mood regulation. No sedation. No systemic medication side effects. No downtime.
Think of TMS like a very focused magnet held against your head. It sends quick magnetic pulses, kind of like tiny, painless taps, through your skull and into a specific part of your brain that helps control your mood. These pulses cause brain cells to fire, almost like jump-starting a car battery. Over many sessions, this helps your brain build new, healthier patterns of activity.
Magnetic Pulses
A coil placed gently on the scalp delivers brief magnetic pulses identical in strength to MRI. These pulses pass painlessly through skin and bone to reach the targeted cortical region.
Targeted Activation
Pulses stimulate neurons in the left dorsolateral prefrontal cortex, a region consistently underactive in major depression. Repeated stimulation restores normal mood regulation.
Durable Response
Most patients begin to notice changes within 2-4 weeks. The full 6-7 week protocol produces effects that studies show last at 3-12 months in 64-90% of responders.
The TMS system in our clinic.
Treatment is delivered with a modern TMS system on a mobile cart. An articulating arm holds the magnetic coil precisely against the scalp, so the same target can be reached comfortably at every visit.
The stimulator delivers brief, focused magnetic pulses while treatment settings are monitored throughout each session from the attached console. No sedation, no anesthesia, and no recovery time are involved.
The course of treatment.
Evaluation
Before treatment begins, you'll meet with Dr. Tharp for a comprehensive TMS evaluation. We confirm medical and psychiatric appropriateness, review your treatment history, and discuss expectations. Insurance benefits and prior authorization are handled by our team.
Daily Sessions
The standard protocol is 36 sessions delivered over 6-7 weeks (typically five sessions per week). Each session lasts under 20 minutes. Patients remain awake, alert, and can drive themselves to and from appointments.
Continued Care
At completion, your referring provider receives an end-of-treatment report including weekly PHQ-9 and GAD-7 scores. We coordinate continuity of care with your primary mental health team.
Nearly two decades of FDA clearance.
TMS has been FDA-cleared as a treatment for Major Depressive Disorder since 2008. Since then, approval has expanded to additional diagnoses and patient populations as the evidence base has matured.
Well-tolerated. Non-systemic.
TMS does not circulate through the body the way oral medications do, which means it does not cause the systemic side effects commonly associated with antidepressants. No weight gain, no sexual side effects, no GI symptoms, no sedation, no cognitive blunting.
Scalp discomfort
A tapping sensation is sometimes reported by patients during the first week. This typically improves as the scalp acclimates. Treatment intensity can be adjusted for comfort.
Mild headache
Occurs in some patients early in treatment. Usually resolves within hours and responds to standard over-the-counter pain relievers if needed.
Seizure
The most serious risk associated with TMS, but rarely observed, occurs in fewer than 7 out of every 100,000 patients (0.007%) during treatment. Risk is minimized by careful patient screening and close monitoring during treatment.
Facial twitching
Some patients may experience brief muscle twitching of the face or jaw during stimulation. This is normal and stops when the session ends.
Candidacy & age requirements.
All candidates are evaluated by Dr. Tharp and her clinical team for medical and psychiatric appropriateness before treatment begins. We do not provide emergency or inpatient services.
Adults 18+ *
- Major Depressive Disorder
- Obsessive-Compulsive Disorder
* Adolescents aged 15–17 may be considered when referred by a Child & Adolescent Psychiatrist.
Adults 18+
- Treatment-Resistant Depression after failure of two or more oral antidepressants
- Depressive symptoms in MDD with acute suicidal thoughts or behaviors
Administered in-office under the SPRAVATO® REMS program.
What insurance requires to cover TMS.
TMS Waco is in-network with Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare. All major insurers cover TMS when specific clinical criteria are met. Our team handles all prior authorizations on your behalf. Patients are not asked to coordinate this themselves.
- Confirmed DSM-5-TR diagnosis of Major Depressive Disorder
- Failed trials of 2 antidepressant medications from different classes at therapeutic dose and duration
- Adequate trial of psychotherapy (typically 6-12 sessions)
- PHQ-9 or HAM-D score documenting current severity
- Prior authorization required before treatment begins
- Confirmed DSM-5-TR diagnosis of Major Depressive Disorder
- Failed trials of 2 antidepressant medications at adequate dose and duration
- Adequate course of evidence-based psychotherapy
- Standardized depression rating (PHQ-9 or equivalent)
- Treatment in an in-network certified facility
- Confirmed diagnosis of moderate-to-severe MDD
- Failed trials of 2 antidepressant medications from different drug classes
- Standardized rating scale documenting severity
- Use of an FDA-cleared TMS device per labeled indication
- Prior authorization required; specifics vary by plan
- Confirmed DSM-5-TR diagnosis of Major Depressive Disorder
- Failed trials of 2 antidepressant medications from different classes at adequate dose and duration
- Documented trial of evidence-based psychotherapy
- Standardized depression rating (PHQ-9 or equivalent)
- Prior authorization required before treatment begins
TMS FAQ.
Is TMS therapy the same as ECT?
Do I have to stop my medications during TMS treatment?
What are the side effects of TMS therapy?
Who is not a candidate for TMS therapy?
How long do the results of TMS treatment last?
Is TMS therapy covered by insurance in Waco?
How long does a TMS treatment session take?
Where can I get TMS therapy near Waco, Texas?
SPRAVATO® (esketamine) nasal spray.
An FDA-approved nasal spray treatment for adults with treatment-resistant depression, administered in-office under direct medical supervision through the SPRAVATO® REMS program.
What is SPRAVATO®?
SPRAVATO® is an FDA-approved esketamine nasal spray, a refined form of ketamine, used to treat adults with treatment-resistant depression (TRD) and depressive symptoms in adults with Major Depressive Disorder (MDD) who have suicidal thoughts or actions.
First approved by the FDA in 2019, SPRAVATO® can be taken with or without an oral antidepressant. Unlike IV ketamine, SPRAVATO® is FDA-approved and covered by most major insurance plans.
- FDA-approved esketamine nasal spray
- 2 oral antidepressant trials typically required for insurance
- Self-administered under clinical supervision
- 2-hour in-office observation per session
- Covered by most major insurance plans
A structured course tailored to each patient.
Treatment plans may vary depending on clinical response. Below is the typical schedule.
What to expect on treatment day.
Arrive at the clinic
Avoid eating for 2 hours and large fluid intake for 30 minutes before your appointment. On arrival, your blood pressure is checked.
Self-administer the nasal spray
Seated in a reclining chair in a private room, you self-administer 2-3 sprays in each nostril (dose determined by your provider).
Monitored observation
Our care team supervises you for at least 2 hours. Blood pressure is checked again at 40 minutes and before discharge.
Arrange a ride home
You may not drive for the rest of the day. By the next morning, most patients resume normal activity with no restrictions.
Administered through the SPRAVATO® REMS program.
SPRAVATO® is available only through a restricted distribution system called the Risk Evaluation and Mitigation Strategy (REMS) program. Our practice is REMS-certified meaning every dose is dispensed and observed by trained medical staff in a controlled clinical setting.
During treatment you may feel dizzy, drowsy, or experience a temporary sense of dissociation. Our care team remains present throughout your session. Side effects typically resolve within hours.
Common contraindications.
SPRAVATO® may not be appropriate for patients with the following conditions. Every candidate is evaluated individually by Dr. Tharp before treatment is offered.
- Uncontrolled hypertension
- History of stroke or intracranial hemorrhage
- Abnormal blood vessels at risk of bleeding (aneurysms or AVMs)
- Known sensitivity to esketamine or ketamine
- Currently pregnant or breastfeeding
SPRAVATO® FAQ.
What's the difference between ketamine, esketamine, and SPRAVATO®?
Who is a candidate for SPRAVATO® treatment?
Can I stay on my current antidepressant during SPRAVATO®?
How long does each SPRAVATO® session take?
Is SPRAVATO® covered by insurance in Waco?
Should I choose SPRAVATO® or TMS therapy for depression?
Care guided by Balance Psychiatry & Wellness.
Katherine Tharp, MD
Dr. Tharp began her career in counseling psychology before pursuing medicine at age 35 at the Texas A&M Health Science Center College of Medicine. She completed her residency at Baylor Scott & White Healthcare in Temple, Texas, receiving the Excellence in Psychiatry Award at both medical school and residency.
After residency she served four years in the United States Air Force as a staff psychiatrist and then as Medical Director, overseeing a large team of clinicians at Nellis Air Force Base. She founded Balance Psychiatry & Wellness in Waco upon leaving active duty.
Dr. Tharp's philosophy: medication and procedures are tools, not endpoints. TMS becomes part of a broader treatment plan designed around the individual: their history, values, and goals, in close collaboration with referring providers.
A trusted TMS partner for Central Texas physicians.
TMS Waco partners with primary care physicians, psychiatrists, and other licensed clinicians across Waco, McLennan County, and the broader Central Texas region. Our mission is to deliver evidence-based TMS therapy while preserving your ongoing relationship with the patient.
Submit the Referral
Complete and return the referral form by secure fax (254-488-3025) or here. We need basic demographics, diagnosis of Major Depressive Disorder, and a note that the patient has failed at least two antidepressant trials. Our intake coordinator will contact your patient within 2 business days.
During Treatment
Patients receive a complimentary TMS evaluation before treatment begins. Throughout the 36-session course, you receive weekly progress updates with PHQ-9 and GAD-7 scores via secure communication.
After Treatment
You receive an End-of-Treatment report including weekly progress notes, validated symptom scales, and overall response summary. We instruct the patient to follow up with you within 2-4 weeks.
Get started today
Choose the option that fits your situation. Both forms go to our intake coordinator, who will follow up within one business day.
Request a Consultation
If you are interested in TMS or SPRAVATO® for yourself, complete the form below. Our team will reach out within one business day to discuss next steps. No physician referral required to inquire.
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Physician Referral Form
Refer a patient from your practice. Provide clinical context so our intake team can begin benefit verification and schedule the patient's initial evaluation efficiently.
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Reach our clinical office.
TMS Waco is located in downtown Waco at the office of Balance Psychiatry & Wellness. We accept communication by phone, secure fax, and encrypted email. We do not provide online booking to maintain HIPAA compliance.
Suite 303
Waco, TX 76701
8:00 AM to 5:00 PM CT
Emergency resources.
TMS Waco is an outpatient, non-emergent service. If you or someone you know is in a mental health crisis or experiencing thoughts of self-harm, please use one of the resources below immediately. These services are free, confidential, and available 24 hours a day.
988 Suicide & Crisis Lifeline
For medical emergencies or imminent danger.
Walk in if you are unable to keep yourself safe.