Maybe it was the weight gain. The emotional numbness. The fatigue that made even small tasks feel impossible. Maybe the first antidepressant helped a little, the second one didn't, and by the third you started wondering if anything was going to work.
If you're a parent reading this, maybe you've watched your teenager struggle through the same cycle of medication adjustments, therapy appointments, missed school days, and you're exhausted too.
That exhaustion, the one that comes from treatment after treatment that doesn't deliver, is real. And it's not your fault.
At Bluegrass Advanced Mental Health, we offer two advanced treatment options, Deep TMS and Spravato®, that work differently than traditional antidepressants.
TMS uses gentle magnetic pulses to stimulate mood-regulating areas of your brain. Spravato® is an FDA-approved nasal spray that works on different brain pathways than standard medications.
Both are delivered under physician supervision, right here in Louisville. You're not out of options.
TMS and Spravato® both work differently than traditional medications.
TMS uses magnetic pulses to stimulate the areas of your brain that regulate mood. No drugs enter your bloodstream, no systemic side effects.
Spravato® (esketamine) is an FDA-approved nasal spray that targets glutamate pathways in the brain, often providing rapid symptom improvement, sometimes within 24 hours.
Both treatments are delivered in our clinic under the supervision of Dr. Roth and our care team. If medication hasn't worked, one of these options may be right for you.
Book a ConsultationDr. Roth will help you determine which treatment is right for you. Here's a quick overview of how they compare.
Transcranial Magnetic Stimulation
Nasal Spray Treatment
Not sure which option is right for you? During your initial consultation, Dr. Roth will review your treatment history and recommend the best path forward. Some patients may benefit from both treatments at different stages of their care.
TMS Treatment
You're in a comfortable chair, fully alert and aware. No sedation, no IV. Some patients read, listen to music, or simply close their eyes.
A padded helmet is positioned gently on your head. You'll hear a clicking sound and feel a light tapping sensation on your scalp as the magnetic pulses are delivered.
When it's over, you drive yourself home or back to work. No downtime, no sedation. No one will know you were in treatment.
Spravato® Treatment
You'll come to our REMS-certified clinic in Louisville. A member of our care team will walk you through the process and answer any questions before you begin.
Under medical supervision, you'll self-administer the Spravato® nasal spray. The process is quick and guided by our clinical team.
You'll stay in a comfortable, private room for about 2 hours while our team monitors your response. Bring a book, listen to music, or simply rest. After the monitoring period, you'll need someone to drive you home.
01 · Evaluation
Dr. Roth reviews your full treatment history, including medications you've tried, therapies you've completed, what's helped and what hasn't. Based on your unique situation, he'll recommend whether TMS, Spravato®, or a combination approach is right for you.
02 · Personalized Plan
Whether TMS or Spravato® is recommended, you'll receive a clear treatment plan with expectations around timing, frequency, and what each session involves. Every plan is tailored to your life, your symptoms, and your goals.
03 · Begin Treatment
TMS sessions take about 20 minutes. Spravato® sessions include a 2-hour monitoring period. Both are delivered in our comfortable Louisville clinic with Dr. Roth's team supporting you at every step.
Dr. David Roth personally oversees every treatment plan and adjusts your protocol based on how you're actually responding.
Spravato® (esketamine) is FDA-approved for adults with treatment-resistant depression and those with acute suicidal ideation. It works on glutamate pathways that standard antidepressants don't touch. Administered in our REMS-certified clinic with full medical supervision.
The BrainsWay Deep TMS H-Coil is designed to stimulate broader and deeper brain regions associated with depression, providing an effective, non-invasive treatment option for patients with treatment-resistant depression.
Traditional daily TMS over a 6-week course, or accelerated protocols including condensed 5-day options for busy schedules.
A non-medication option for teens and adults alike, with families included in the healing process for younger patients.
We're not a corporate chain. We're your neighbors. Bluegrass was founded by Dr. Roth, a third-generation Louisvillian, and built on relationships, trust, and community.
Dr. David Roth is a triple-board-certified physician in Adult Psychiatry, Child & Adolescent Psychiatry, and Pediatrics — the only combination of its kind in Louisville — with nearly 30 years of medical experience.
After decades of clinical innovation in the San Francisco Bay Area, where he trained under national TMS pioneers and worked alongside leaders in interventional psychiatry and neuromodulation, Dr. Roth made a deliberate choice: return home to Kentucky and build a center of hope and healing for the community he loves.
Request Your Consultation
Not everyone's life looks the same. That's why Bluegrass offers two TMS protocols, so your treatment fits your schedule, not the other way around.
Dr. Roth will help you determine which protocol is right for you during your initial consultation. There's no wrong choice, only the one that fits your life.
We're in-network with most major insurers, and our team handles the entire prior authorization process for you, whether you're pursuing TMS or Spravato®.
Both treatments are covered by most major insurance plans when criteria are met. Before treatment begins, we'll provide complete cost transparency. No surprise bills, no guessing.
For patients without insurance or with high deductibles, we offer flexible payment options for both TMS and Spravato® designed to reduce financial barriers. Let's have the conversation openly, honestly, and without pressure.
Most patients say no. You'll feel a tapping sensation on your scalp, and some experience mild scalp tenderness during the first week that fades quickly. Unlike ECT, TMS requires no anesthesia. You're awake and comfortable throughout.
Yes. TMS is FDA-cleared for patients ages 15 and older with major depressive disorder. Dr. Roth is board-certified in child and adolescent psychiatry, and our clinic is designed to feel safe and age-appropriate for teens and adults alike.
Completely different treatments. ECT uses electrical currents to induce a seizure and requires anesthesia. TMS uses magnetic pulses. No electricity, no seizure, no anesthesia, no memory loss. You can drive yourself home afterward.
A standard treatment course spans 6 weeks, though some patients notice improvements as early as week two or three.
Dr. Roth monitors your progress and adjusts your protocol based on your individual response. Hanlon et al., Brain Stimulation (2026) reported an 87.8% response rate and a 78% full remission rate for clinical outcomes.
Most major plans cover TMS for treatment-resistant depression when certain criteria are met, typically a history of trying at least one antidepressant without adequate relief.
Our team handles all prior authorizations.
No treatment works for everyone, but TMS has strong evidence behind it. If TMS isn't the right fit, Dr. Roth also offers Spravato® (esketamine) therapy and comprehensive medication management.
Spravato® (esketamine) is FDA-approved for adults with treatment-resistant depression both for use in combination with an oral antidepressant and as monotherapy. It works on the glutamate system in the brain, a different pathway than traditional antidepressants, which target serotonin.
Many patients experience rapid improvement, sometimes within the first 24 hours of treatment.
You self-administer the nasal spray under medical supervision in our REMS-certified clinic.
After taking the dose, you'll stay in a comfortable, private room for about 2 hours while our team monitors your response. You'll need someone to drive you home afterward.
Spravato® (esketamine) is an FDA-approved, standardized nasal spray formulation delivered in a certified medical setting with specific safety monitoring protocols.
Ketamine infusions are typically IV-based, often used off-label, and may not include the same level of standardized monitoring. Spravato's® REMS program ensures consistent, safe administration.
Yes. Spravato® is FDA-approved both for use in combination with an oral antidepressant and as monotherapy. Dr. Roth will review your current medications during your evaluation and determine the best approach for you.
Fill out the form and our care coordinator will follow up within 24 hours to answer questions, verify your insurance, and schedule your initial consultation.
Dr. Roth will help determine whether TMS, Spravato®, or a combination approach is right for you.
Hear from people who've been where you are.
Jasmin
“Dr. Roth’s support and TMS treatments have been huge. Through the work we've done together, especially during the time I was pregnant, I've been able to be more grounded and regulated - which is everything, especially as a parent.”
Angelica
"Dr. Roth is the best thing that could have happened to me. As someone who was once very skeptical of medications and the realm of psychiatry, I’m glad I allowed myself the opportunity to try something new and to be guided by him."
Aaron
"Dr. Roth is very knowledgeable about the latest OCD research and treatment approaches which allows him to provide the best options. He has a very warm bedside manner and is a pleasure to work with."