Depression options compared by what they ask of the household

Most comparisons of depression treatments are written for the patient. They cover mechanism, evidence, and side effects. What they rarely cover is the person who ends up rearranging the week: the spouse who drives, covers school pickup, fields insurance calls, and waits in the lobby. If that is you, this comparison is built around your side of the equation.

Why start with drug-free?

Because that is where most people's preferences point. Of the 443 Midwest adults in the poll we paid for, 64 percent say it matters to them that an option skips medication. Only 25 percent of those respondents could explain what TMS is. The figures are final, and they hint that many couples compare options with half the menu missing.

Below are five paths compared by what they typically ask of a household. Details vary by clinic, plan, and person. Whether any of them fits your partner is a question for their clinician.

Psychotherapy

• Medication involved: None.
• Visit rhythm: Commonly once a week, for months.
• Driving: Your partner can drive, and many sessions can happen by video.
• Time off work: Usually an hour a week, sometimes schedulable outside work hours.
• Your likely role: Encouragement, protecting that hour on the calendar, and occasionally joining a session if your partner and the therapist think it would help.

This is the lightest household lift of the five. The hard part is often finding an in-network therapist with openings.

TMS (transcranial magnetic stimulation)

• Medication involved: None.
• Visit rhythm: Often every weekday for about four to six weeks.
• Driving: Your partner can usually drive themselves. There is no anesthesia.
• Time off work: Short sessions, but daily, so travel time adds up.
• Your likely role: Helping the calendar absorb a daily appointment, possibly adjusting childcare or car sharing, and helping assemble the medication history insurers usually require.

TMS is FDA-cleared for adults with major depression that has not improved on antidepressants. It is the drug-free option most families have not heard of. The biggest household factor is distance. A clinic 15 minutes away and a clinic 55 minutes away are very different commitments when you multiply by 20 to 30 visits.

ECT (electroconvulsive therapy)

• Medication involved: No antidepressant, but general anesthesia each session.
• Visit rhythm: Commonly two or three times a week for several weeks, usually at a hospital.
• Driving: Your partner cannot drive on treatment days.
• Time off work: Often significant during the course, including recovery time.
• Your likely role: Transportation, being present after sessions, and helping track any memory problems to report to the team.

ECT is an established treatment for severe or resistant depression. It asks the most of a household, and it is typically considered when other options have not worked.

A medication change

• Medication involved: Yes.
• Visit rhythm: A prescriber visit, then follow-ups every few weeks.
• Driving: No restriction in most cases.
• Time off work: Minimal.
• Your likely role: Noticing and gently noting changes in mood or side effects over several weeks.

This is the path of least logistics, which is part of why it gets repeated. It does not meet a drug-free preference.

Esketamine (Spravato)

• Medication involved: Yes. The FDA approved this nasal spray for depression that other treatment failed to lift; see this overview of Spravato care.
• Visit rhythm: Typically twice weekly early on, then less often. Each visit includes at least two hours of observation in a certified clinic.
• Driving: Plan for a second driver; your partner is off the road for the rest of that day and needs a full night of sleep first.
• Time off work: Several hours per visit, often for both of you if you are the driver.
• Your likely role: Regular driver, especially during the first weeks.

Because it is a medication, esketamine does not answer a drug-free preference, and it sits in a different category from at-home ketamine products, which lack FDA approval for depression. For couples open to medication, it is a supervised option to ask about.

What most people want from the setting

Our survey asked where people would want treatment to happen. An in-person clinic led at 44 percent. A clinic-first-then-home model came next with 23 percent, and at-home telehealth followed at 22 percent. Taken together, the clinic-only and clinic-then-home answers mean 67 percent wanted a clinic involved in some form. That preference fits TMS, ECT, and esketamine, all of which happen in person. It also means the drive is part of the treatment.

Money and the household

Coverage decides a lot. Given a choice between an insured route with more hoops and a simpler route paid out of pocket, just over half of respondents picked the insured route and fewer than a quarter picked paying themselves. The rest were not sure. For TMS in particular, the cost is per session, so a deductible and coinsurance can stack up across a daily course. Request a written price for the whole series first.

A quick word on your own limits

It is easy for the driver, scheduler, and insurance caller to run out of steam halfway through a course. Before you commit to a path that leans on you, be honest about what you can sustain for six weeks, not just the first one. If a friend, adult child, or neighbor can take a few of the drives, line them up early. A plan that protects your energy is more likely to be finished.

How to use this with your partner

Sit down with the list and ask two questions: "Which of these fit what you want?" and "Which of these can our week actually handle?" Then bring both answers to the doctor. Of our respondents, 74 percent named their own doctor's advice as what would get them to try something new, so that visit is where this comparison earns its keep.

Nothing here is medical advice or a prediction of results. Your partner's clinician is the right person to weigh their history against these options.

If the person you love is thinking about suicide, or you fear for their safety, 988 reaches a Suicide and Crisis Lifeline counselor by voice or text at whatever hour it is. Call on their behalf, sit beside them while they reach out, or use it for your own sake.

Methodology

Our publisher commissioned and bankrolled this household-options study. Pollfish ran it until June 23, 2026, gathering 443 answers from people 18 to 64 in Iowa, Illinois, Nebraska, Ohio, Minnesota, Wisconsin, Kansas, Indiana, Missouri, and Oklahoma. Figures are final and validated, and our one combined number is labeled.