Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial.

Owen Muir, MD, DFAACAP, FCTMSS

A secondary analysis of BrainsWay's pivotal SWIFT trial found accelerated Deep Transcranial Magnetic Stimulation (Deep TMS) resolved 

faster than standard once-daily dosing.¹ Among 89 enrolled patients, the proportion with suicidal ideation fell from 22.5% at baseline to 6.7% after 6 weeks, a 70% relative reduction.¹ Median time to improvement was 10 days with the SWIFT protocol versus 13 days with standard dosing, a statistically significant difference.¹

Suicidal ideation remains a persistent challenge in MDD, and the US Food & Drug Administration (FDA) cleared SWIFT in September 2025 based on the same multisite randomized trial these suicidality outcomes were drawn from.¹ The trial excluded the most severely suicidal patients at baseline.

In an interview with HCPLive,Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial, said excluding patients with severe suicidality made the findings more meaningful since more severe scores tend to regress toward the mean. In this Q&A, Muir discusses the trial findings, the limitations, and next steps for research and coverage policy.

Q&A: Accelerated TMS Speeds Suicidal Ideation Relief, With Owen Muir, MD

What does the 3–4-day difference in time to improvement in suicidal ideation mean for a patient who is actively struggling?

 Patients who aren't suicidal don't have to sit around struggling with their suicidal thoughts. There isn't a day with suicidality that I wouldn't trade for a day without it. This is a better treatment for suicidal people in that their suicidality will be gone faster, and their depression shortly thereafter.

Is there a possible mechanism for why anti-suicidal effects might separate from general antidepressant effects?

 The paper does not answer that question. There has long been genetics suggesting that suicidality is differently mediated than depression overall, and suicidality exists in conditions other than major depressive disorder. As a clinician, I do think suicidality is related to but separate from major depressive disorder.

Is it a symptom of depression? Yes. Might it follow different time courses in different people than depression scores broadly speaking? Yes.

An important clarifier for this study is that extremely suicidal people were screened out of the trial. I had one patient screened out at my site who didn't meet criteria because she was too suicidal for the study, but in clinical practice, TMS was judged to be the safest and most effective treatment for her suicidality, and she remitted.

The full sample of the most suicidal people isn't captured in this data set, because as an FDA approval trial, the most suicidal patients were screened out. That makes these outcomes even more significant, because very high numbers tend to regress to the mean, and we lopped off the very highest in suicidality.

We only had modest suicidality in the trial, and we still saw that improvement, which is actually statistically less likely. Since we limited the sample to people who were modestly, but not severely, suicidal, and still saw the difference, it gives me even more hope that this will be effective in the more severely suicidal individuals we see in clinical practice.

What would it take from a trial design standpoint to isolate a true anti-suicidal effect?

 We'd want to power the trial to look at anti-suicidality as the primary endpoint. You'd want to enroll everyone who had suicidality, whether from OCD, bipolar disorder, schizophrenia, depression, or borderline personality disorder. Across that broad range of diagnoses, we'd want to see reliable reductions in suicidality, ideally independent of effects on the primary diagnosis. You'd want a treatment that wouldn't be expected to affect OCD, BPD, or general depression symptomatology, but that still exhibited a profound anti-suicidal effect.

I don't know that we're going to have that, but not being suicidal does selectively happen. I have patients who are quite depressed and not suicidal after some versions of accelerated TMS treatment. I just talked to one of them this morning; the depression and anhedonia were still present, but the suicidality had completely vanished. We'd need a better understanding of who to include and exclude from that sort of trial.

How should clinicians interpret these suicidal ideation findings, given the cohort wasn't the most severely at-risk population?

 These are some very unwell people. I don't want to say they weren't severely at risk; I'm saying they weren't so severely at risk that they couldn't be included in an FDA trial. I think this generalizes to most patients seen in clinical practice, but not necessarily all.

That said, this is an RCT compared against a standard-of-care treatment that's been deployed in the field for decades. Does TMS work in suicidal patients? At scale, we know the answer is yes.

We answered the question of whether it's possible to get suicidality to remit even faster with this more efficient dosing schedule: yes. And we know from clinical practice that very severely suicidal people can have their suicidality remit entirely.

My biggest takeaway is that if you're looking at time to remission of suicidality, accelerated TMS is the clear choice, and it might even be something you choose before inpatient psychiatric hospitalization. Most inpatient psychiatric hospitals don't have access to the SWIFT protocol because of the way their payment structures are set up, not because they shouldn't. They definitely should put a BrainsWay H1 Coil on the unit so they can start doing this.

Where does accelerated Deep TMS fit into your treatment algorithm for patients with MDD and active suicidal ideation?

 This is a go-to, first-line treatment for patients with acute suicidality. I think accelerated SWIFT TMS is the fastest thing I can do and still be confident that I'm going to relieve suicidal ideation in a patient who's suffering. These numbers aren't directly compared to esketamine, but they're actually better than the numbers in esketamine treatment, and we'll have more large-scale data on that soon. This is the treatment in my practice for acutely suicidal individuals who are suffering, because I don't have to spend additional time getting an fMRI scan.

What's the next research question needed to move this from an exploratory finding to changing practice guidelines?

 What really needs to change is coverage policies.

What I want is to replicate this in larger-scale data, and I think the way to get that is to have coverage policies reliably pay for accelerated TMS, with appropriate coding and billing. That would let us do a mirror-image design in the real world: look retrospectively at patients who got once-daily TMS before SWIFT, look at patients who've gotten SWIFT TMS en masse, and see if this finding replicates in that large real-world dataset. For that to happen, payers need to reliably pay and treat suicidality as something worthy of a yes-or-no decision the day the patient is evaluated, not something that takes days to weeks to adjudicate.

My dime has been on this since 2017, when we first had an open-label patient show a one-day remission with accelerated Deep TMS, and the data has only accumulated from there.

Deep TMS Reduces Suicidal Ideation by 70% in MDD, With Owen Muir, MD

Accelerated Deep TMS for Acute Suicidality, With Owen Muir, MD

BrainsWay. BrainsWay Deep TMS™ study shows 70% reduction in patients experiencing suicidal ideation. Published August 27, 2026. Accessed September 2, 2026. 

globenewswire.com/news-release/2026/08/27/3351903

Articles

Accelerated Deep TMS using the SWIFT protocol was associated with faster resolution of suicidal ideation than standard once-daily dosing in adults with MDD. In a secondary analysis of a multisite randomized trial (n=89), suicidal ideation decreased from 22.5% at baseline to 6.7% at 6 weeks (70% relative reduction), with median time to improvement of 10 versus 13 days. FDA clearance in September 2025 followed this trial, though individuals with the most severe baseline suicidality were excluded, limiting generalizability.

SWIFT accelerated Deep TMS resolved suicidal ideation faster than standard dosing, Owen Muir, MD, says.

Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial, said accelerated SWIFT Deep TMS has become his personal first-line treatment approach for patients with 

and active suicidal ideation. This clinical practice pattern predates current professional guideline recommendations. As of now, the Cleveland Clinic, last medically reviewed in 2024, recommends a safety plan, cognitive behavior therapy, medications, or inpatient or outpatient mental health programs for patients with suicidal ideation.

Muir authored the first large-scale open-label comparison of once-daily versus accelerated Deep TMS dosing in 2020, work preceding the FDA clearance of the SWIFT protocol in September 2025.

No current American Psychiatric Association (APA) or American College of Physicians (ACP) guideline designates TMS as first-line specifically for acute suicidality.

Intranasal esketamine, not TMS, currently holds FDA approval for MDD with active suicidal ideation.

 Muir said he considers accelerated Deep TMS numbers favorable relative to esketamine outcomes, though he noted the treatments have not been directly compared in a head-to-head trial.

"This is a go-to treatment," Muir said. "This is a first-line treatment [for] patients with acute suicidality.”

SWIFT Deep TMS Access and Real-World Feasibility

Radial has built its clinical program, now spanning 27 sites, around delivering accelerated Deep TMS protocols.

 Muir said patients overwhelmingly prefer the compressed schedule to standard once-daily dosing, since no one wants to remain suicidal any longer than necessary, and he described high satisfaction among both patients and clinicians with the approach. He identified scheduling infrastructure, not efficacy, as the main barrier keeping other practices from adopting accelerated protocols at scale.

Advancing SWIFT Deep TMS Evidence and Payer Coverage

Is accelerated Deep TMS officially first-line for acute suicidal ideation?


No professional guideline currently designates it as such. Owen Muir, MD, describes it as his personal first-line approach based on his own clinical practice and research.

What has to change for accelerated Deep TMS to influence broader practice guidelines?


Muir wants larger real-world replication using retrospective, pre/post-SWIFT comparisons, which he said requires payers to reliably cover accelerated TMS with same-day authorization decisions.

Muir said the next step toward influencing practice guidelines is replicating the suicidality findings in larger real-world datasets using a mirror-image design, comparing retrospective outcomes before and after SWIFT adoption. He said this depends on payers reliably covering accelerated TMS with appropriate billing codes and treating suicidality evaluations as same-day coverage decisions rather than prior authorizations spanning days to weeks.

Muir disclosed he was himself treated with Deep TMS during a suicidal episode tied to bipolar depression, selecting a BrainsWay coil based on available data before later becoming a TMS researcher.

“Everyone deserves the opportunity to let the suicidality go, and I will stop at nothing to make this a standard of care,” Muir said.

Watch part 1 of our interview with Muir on new Deep TMS data here: 

Editor’s note: Reported disclosure for Muir includes Medtronic.

Suicidal Ideation (Suicidal Thoughts). Cleveland Clinic. Published July 23, 2024. Accessed September 3, 2026. 

https://my.clevelandclinic.org/health/symptoms/suicidal-ideation

Tendler A, Goerigk S, Zibman S, et al. Deep TMS H1 Coil treatment for depression: Results from a large post marketing data analysis. 

Walters J. FDA Clears Accelerated Protocol for Deep TMS to Treat Major Depressive Disorder. PsychiatricTimes. Published September 17, 2025. Accessed September 3, 2026. 

https://www.psychiatrictimes.com/view/fda-clears-accelerated-protocol-for-deep-tms-to-treat-major-depressive-disorder

Kunzmann K. FDA Approves Esketamine for Depressive, Suicidal Symptoms. HCPLive. Published August 4, 2020. Accessed September 3, 2026. 

https://www.hcplive.com/view/fda-approves-esketamine-depressive-suicidal-symptoms

BrainsWay Deep TMS™ study shows 70% reduction in patients experiencing suicidal ideation. BrainsWay. Published August 27, 2026. Accessed September 2, 2026. 

Videos

Owen Muir, MD, calls accelerated SWIFT Deep TMS his personal first-line approach for active suicidal ideation, not an established guideline.

Deep Transcranial Magnetic Stimulation (Deep TMS) produced a 70% relative reduction in the proportion of patients experiencing 

, with the accelerated SWIFT protocol easing suicidal ideation at a median of 10 days compared with 13 days for standard once-daily dosing.

The analysis draws on data from BrainsWay's multisite randomized non-inferiority trial comparing the SWIFT accelerated Deep TMS protocol with standard once-daily dosing, the same trial supporting FDA clearance of SWIFT in September 2025.

Deep TMS holds FDA clearance for major depressive disorder, including anxious depression, obsessive-compulsive disorder, and smoking addiction, but carries no FDA clearance for treating or preventing suicidal ideation or suicidal behavior.

 The publication adds to a growing 2026 literature examining deep TMS and suicidality, including a sham-controlled trial in hospitalized patients with active suicidality and a review of 108 studies on suicidality interventions.

"Patients who aren't suicidal don't have to sit around struggling with their suicidal thoughts," said Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial. "It's better to not be suicidal."

SWIFT Accelerated Deep TMS Efficacy in Suicidal Ideation Reduction

The trial enrolled 89 patients across multiple sites in a randomized comparison of SWIFT accelerated deep TMS dosing against standard once-daily deep TMS dosing, using the Scale for Suicide Ideation (SSI) to track suicidality throughout treatment.

Investigators found the number of patients with any suicidal ideation (SSI>0) fell from 22.5% (20/89) at baseline to 6.7% (6/89) after 6 weeks of treatment, a 70% relative reduction across both dosing arms.¹ Patients assigned to SWIFT reached a median ≥ 1-point SSI improvement in 10 days, compared with 13 days for patients on the standard once-daily protocol, a statistically significant difference.¹

Muir noted many study sites delivered SWIFT over 3 half days per week across 2 weeks rather than 6 consecutive days, the compressed schedule he uses in his own clinical practice. He raises the possibility further gains in speed remain unmeasured in the trial data.

Deep TMS Safety Profile and Regulatory Status in Suicidal Ideation

A secondary analysis found a 70% relative reduction in suicidal ideation with deep TMS, with SWIFT accelerated dosing improving suicidality faster than standard once-daily dosing (10 vs 13 days).

The trial excluded the most severely suicidal patients at baseline, and Deep TMS remains FDA-cleared for MDD, OCD, and smoking addiction, not specifically for suicidal ideation.

Owen Muir, MD, of Radial, said the trial's modular 3-day-per-week dosing schedule leaves open whether even faster suicidality relief is possible with 6 consecutive days of SWIFT.

Muir cautioned the trial population excluded patients with the most severe suicidality at baseline, screened per FDA trial requirements. This means that outcomes reflect a moderately suicidal cohort rather than the most acutely at-risk patients seen in clinical practice.

He characterized the divergence between faster suicidality improvement and slower overall depression scores as likely statistical noise rather than a distinct mechanism, since the trial was not powered to detect a difference in suicidality as a standalone endpoint.

"My biggest takeaway here is if you're looking at time to remission of suicidality, accelerated TMS is the clear choice," Muir said.

BrainsWay. BrainsWay Deep TMS™ study shows 70% reduction in patients experiencing suicidal ideation. Published August 27, 2026. Accessed September 2, 2026. 

Roth Y, Tendler A, Brink E, et al. Effects of H-coil TMS on suicidality in major depression: A secondary analysis of data from a multisite randomized trial comparing accelerated to once-a-day stimulation. 

Accelerated TMS with the H1-coil for depression: A multisite, randomized non-inferiority trial. 

George MS, Raman R, Benedek DM, et al. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. 

A secondary analysis found the SWIFT accelerated protocol eased suicidal ideation faster than standard daily deep TMS dosing in major depressive disorder.