Scott A. Wilke, MD, PhD, an assistant professor of psychiatry and the Penske Family Chair in Neuromodulation at UCLA Health.

Scott A. Wilke, MD, PhD

This video features Linda Carpenter, MD, Professor of Psychiatry and Human Behavior at Brown University, Andrew Leuchter, MD, Professor and Director of the Neuromodulation Division at UCLA TMS Clinical and Research Services, and Scott Wilke, MD, PhD, Assistant Professor of Psychiatry and Penske Family Chair in Neuromodulation at UCLA Health, discussing accelerated TMS protocols, at-home brain stimulation, and new mechanistic data in the treatment of major depressive disorder. Topics include accelerated TMS for treatment-resistant depression, the 5x5 accelerated rTMS protocol, the SWIFT deep TMS protocol, theta burst stimulation, intermittent theta burst stimulation, deep TMS for MDD, ProlivRx FDA approval, at-home neuromodulation for major depressive disorder, the MOOD trial, physician-directed brain stimulation therapy, TMS insurance coverage, TMS reimbursement 2026, Medicare TMS coverage, TMS after antidepressant failure, prefrontal cortex neuromodulation, intratelencephalic neurons, personalized TMS treatment, TMS patient access, accelerated TMS efficacy, TMS vs conventional treatment, TMS clinical practice, treatment-resistant MDD, TMS psychiatry 2026, brain stimulation therapy for depression, noninvasive brain stimulation, repetitive transcranial magnetic stimulation, rTMS for depression, deep transcranial magnetic stimulation, TMS schedule, TMS protocol comparison, TMS outcomes, PHQ-9 TMS, HDRS TMS, TMS remission rates, TMS response rates, TMS delayed response, TMS maintenance, TMS and antidepressants, TMS adjunctive therapy, neuromodulation psychiatry, interventional psychiatry, brain stimulation MDD 2026.

 TMS for MDD Is Changing Fast. Here's What Psychiatrists Need to Know

Transcranial magnetic stimulation (TMS) has been 

 since 2008, but for many patients with treatment-resistant depression (TRD), the traditional TMS treatment schedule has been the biggest obstacle to accessing it.

 The standard protocol requires 36 sessions, once daily, over 6 to 8 weeks, a commitment that costs patients their mornings, their commutes, and sometimes their jobs. For those living far from a TMS clinic, it has often meant no treatment at all.

In this video, 3 clinician-researchers, Linda Carpenter, MD, of Brown University; Andrew Leuchter, MD, of UCLA TMS Clinical and Research Services; and Scott Wilke, MD, PhD, Penske Family Chair in Neuromodulation at UCLA Health, walk through what is new in TMS for MDD and what it means for practicing psychiatrists treating patients who have not responded to antidepressants.

What New TMS Protocols for Treatment-Resistant Depression Mean for Clinical Practice

The clinical case for accelerated TMS protocols is building. A retrospective analysis published in March 2026 found that a

, 5 sessions per day over 5 consecutive days, produced efficacy comparable to the conventional 6-week TMS course.

 As Leuchter explained in an interview with 

, the compressed timeline has real implications for patient access and adherence, though insurance reimbursement for accelerated TMS approaches remains a significant gap.

—yet access barriers have limited TMS use in TRD for nearly 2 decades.

—a March 2026 retrospective analysis found comparable outcomes between 5x5 accelerated rTMS and the conventional 6-week daily course (

remission rates for ProlivRx vs sham in the MOOD trial (

 — Medicare reimburses up to 2 TMS sessions per day; accelerated protocols of 5 or more sessions per day remain unreimbursed as of 2026.

On the at-home neuromodulation front, the

 FDA approved Neurolief’s ProlivRx in January 2026

, the first prescription, physician-directed at-home brain stimulation therapy for MDD, indicated for adults who did not achieve satisfactory improvement from ≥ 1 prior antidepressant.

 Carpenter, who led the MOOD trial studying the device as adjunctive therapy, describes how the physician-directed model works in practice and what the current reimbursement landscape looks like for patients.

Wilke adds mechanistic context on how accelerated intermittent theta burst stimulation acts on specific cell types in the prefrontal cortex and what that could mean for personalizing TMS treatment for MDD.

For a deeper dive into the data behind each of these developments, read the full written feature here: 

TMS for MDD Reimagined: Faster, Fewer Visits, and Now at Home

Editor’s note: Reported disclosures include Neuronetics and Janssen Pharmaceuticals for Carpenter and Abbott Laboratories for Leuchter. Wilke has no reported disclosures.

Patel, P. The FDA Approved TMS For Treating Depression In 2008. TMS Institute of Arizona. Published May 13, 2025. 

https://tmsinstitute.co/the-fda-approved-tms-for-treating-depression-in-2008/

Leuchter A. Accelerated 5×5 rTMS Matches Standard Protocols in TRD, With Andrew Leuchter, MD. HCPLive. Published on March 24, 2026. Accessed June 18, 2026. 

https://www.hcplive.com/view/accelerated-5-5-rtms-matches-standard-protocols-trd-andrew-leuchter-md

Derman C. Accelerated Deep TMS Matches Standard Outcomes in TRD in 6 Days. HCPLive. Published on March 18, 2026. Accessed June 18, 2026. 

https://www.hcplive.com/view/accelerated-deep-tms-matches-standard-outcomes-trd-6-days

Derman C. FDA Approves ProlivRx, First At-Home Neuromodulation Device for MDD. HCPLive. Published on January 13, 2026. Accessed June 18, 2026. 

https://www.hcplive.com/view/fda-approves-proliv-rx-first-home-neuromodulation-mdd

Derman C. TMS for MDD Reimagined: Faster, Fewer Visits, and Now at Home. HCPLive. Published on May 15, 2026. Accessed June 18, 2026. 

https://www.hcplive.com/view/tms-mdd-faster-fewer-visits-home

Videos

New accelerated TMS protocols and an FDA-approved at-home device are changing how psychiatrists treat MDD after antidepressant failure.

TMS for MDD Is Changing Fast. Here's What Psychiatrists Need to Know

Scott Wilke, MD I Image Credit: UCLA Health

Although transcranial magnetic stimulation (TMS) has been FDA-approved for 

since 2008, investigators are still working to understand exactly how brain stimulation reshapes neural circuits to produce antidepressant effects. New preclinical findings published in Cell offer some of the clearest mechanistic evidence to date, suggesting accelerated intermittent theta burst stimulation (aiTBS) may selectively restore stress-disrupted brain circuitry rather than broadly activating the brain.

In this Q&A, Scott Wilke, MD, assistant professor of psychiatry and the Penske Family Chair in Neuromodulation at UCLA Health, discusses how accelerated TMS protocols are beginning to change clinical practice, what the new research could mean for more personalized neuromodulation strategies in the future, and why clinicians should view TMS as an increasingly mainstream option for patients with treatment-resistant depression. Wilke also addresses ongoing barriers to access, realistic expectations for response timing, and where accelerated protocols may ultimately fit into psychiatric care.

Standard TMS has been around since 2008. When did accelerated protocols start feeling like a genuine paradigm shift rather than just an experimental tweak?

Traditionally, people have thought of depression as something that takes weeks or months to improve. In the last 10 to 20 years, we've accumulated evidence that you can treat depression rapidly, and then with TMS treatments, we've started to use them in our clinic in the last year or two.

 Your findings suggest TMS may work through more specific neural circuits than previously understood. Could this help explain why some patients respond well to TMS while others do not, and how might that shape more personalized approaches to treatment in the future?

We thought maybe these TMS treatments are modulating all of the neurons similarly, and it's remarkable that what we find is that it's actually having distinct effects on distinct cell types. What would be really cool is if it turns out that we can tune the TMS treatment to target specific circuits and cell types.

Could you walk me through how you currently identify candidates for the accelerated protocol versus the standard schedule?

The major limitation right now with accelerated treatments is that insurance companies typically don't cover accelerated treatment. It's important to underline the fact that standard treatment is still the gold-standard approach to depression.

One of the variables is [that] some people just can't make it in for one treatment every day for 6 or 7 weeks. It's too difficult with their schedule, but they might be able to set aside 1 day or 1 week where they could come. In those cases, we might direct people towards accelerated treatment.

The other [limitation] is…an access issue with TMS clinics. We often run into the situation where someone lives far away, and driving [to] the clinic every day for that long is really burdensome for them. But again, that's a situation where they could come and maybe stay in the area for a week and get an accelerated treatment.

It's too early to start talking about this clinically, but there may be cases that are more acute, where the consequences of not treating the depression…could be so dire that you really need an accelerated treatment. Accelerated treatments might find a role in the hospital when people are [in an] inpatient psychiatry unit or maybe even in the emergency department.

Response timing seems underappreciated, with some patients taking days or weeks to feel benefit. How do you prepare patients for that, and how do you prevent premature dropout?

It's important for people to have a realistic understanding of what might happen with treatment. I always prepare patients for that. You start with something that you think is most likely to work. We think it takes about 5 to 10 treatment sessions before we really know if we're on the right track or not. People should know that they could start improving within the first week or two, but if they're not improving, there are adjustments that we can make to try to get the TMS treatment working better.

Importantly, people shouldn't become frustrated if they're not getting better right away. We definitely see patients get better halfway… [or] three-quarters of the way through. Even some patients who've done the whole treatment course and say they're not much better… [will] come back 6 months later and say that they actually did find that even after the treatment was over, they continued to improve and had a significant benefit.

For a psychiatrist with a treatment-resistant patient in front of them right now who has failed two or three antidepressants, what do you want them to know about what's available today?

It's a really exciting time for depression treatment. I can't think of a time in my career where I had more hope for those patients [who] weren't responding to medications. [It] used to be that there's just 1 or maybe 2 things that people could try at that point, for example, electroconvulsive therapy, which is effective but has a lot of potential side effects.

What I would communicate to clinicians is that this is not an experimental approach at this point. It's not a last-ditch effort to get people better. This is a legitimate treatment that probably should be considered in the future, something you should do earlier when people are depressed… [and] if they aren't responding to medications. It can [even be] an alternative path for people who would prefer not to take medications. The insurance structure right now doesn't typically allow that, but… we may find that that shifts over time.

TMS is really the best… next step…for someone who has not responded to antidepressant medications. This is a field that is rapidly evolving now, and I think there's going to be a lot of exciting changes in the coming years that will make this an even more attractive route for patients.

Scientists finally see inside the “black box” of depression treatment. Uclahealth.org. Published May 7, 2026. Accessed May 14, 2026. 

https://www.uclahealth.org/news/release/scientists-finally-see-inside-black-box-depression-treatment

Articles

In a Q&A, psychiatrist Scott Wilke, MD, explains how accelerated TMS protocols are reshaping depression care and may help tailor treatment to specific neural circuits.