Accelerated Deep TMS Matches Standard Outcomes in TRD in 6 Days

Accelerated deep transcranial magnetic stimulation (dTMS) delivered over 6 days achieved clinical outcomes comparable to standard multiweek treatment in patients with major depressive disorder (MDD), according to 2 newly published manuscripts in Brain Stimulation.1,2,3

“By significantly reducing the time and travel, and improving time to remission, accelerated protocols like SWIFT may help more patients start and complete safe and effective treatment,” said Radial Chief Medical Officer and Co-founder Owen Muir, MD, in a statement.

In a statement, Radial announced that accelerated SWIFT™ protocol reduced the acute treatment phase from approximately 36 visits to 6 half-day sessions, followed by weekly maintenance treatments.3

Repetitive TMS is an established nonpharmacologic option in treatment-resistant depression (TRD), but conventional protocols requiring daily sessions over 4 to 6 weeks can limit access and adherence. In one study, investigators compared a 5-times-daily accelerated intermittent theta burst stimulation (ACC-iTBS) protocol with the standard of care high-frequency (SOC-HF) H1 coil TMS protocol in adults with MDD.1 In a second study, the team sought to systematically define and standardize how dose-response relationships are conceptualized, measured, and reported in transcranial brain stimulation.2

Accelerated Deep TMS’s Comparable Efficacy to the Standard of Care

In a non-inferiority trial, Colleen A. Hanlon, PhD, from Wake Forest University, and colleagues randomized 104 adults with moderate-to-severe MDD to either accelerated deep TMS (n = 41) or SOC-HF (n = 48).1 The primary endpoint was the change in HDRS-21 score at week 6, and secondary endpoints included response, remission, anxiety, and adverse events.

Accelerated deep TMS consisted of 5 ACC-iTBS (110%rMT, H1 coil) sessions per day for 6 days, plus 1 day a week with 2 sessions for 4 weeks. SOC-HF (120%rMT, H1 coil) involved once-daily sessions for 4 weeks (20 sessions), followed by 2 sessions/week for 2 weeks (4 sessions).

Patients receiving accelerated treatment achieved a comparable response and remission rate to standard of care (87.8% vs 87.5% and 78.0% vs 87.5%, respectively). Median time to remission was 21 days with accelerated treatment versus 28 days in the standard protocol group (P =.0324). ACC-iTBS demonstrated faster symptom reduction by week 2 (median HDRS change, −11.70 vs. −8.590). These findings suggest that compressing treatment delivery may allow for faster symptom improvement without compromising overall outcomes.1

Accelerated treatment also showed meaningful improvements in quality of life and functioning, with approximately 60% of participants returning to normal-range functioning following treatment.1

Deep TMS, which uses specialized coil designs to stimulate broader cortical regions than conventional TMS, has received clearance from the US Food and Drug Administration for MDD.4The ability to deliver effective treatment within a shorter timeframe may represent a meaningful advance for patients facing logistical barriers to care, though real-world implementation considerations remain.

Second Study Proposes Multidimensional Framework for TMS Dose-Response

A study published 3 days after the non-inferiority trial provides a conceptual framework for understanding dose-response relationships in transcranial brain stimulation, with direct relevance to interpreting accelerated protocols.2 Ghazaleh Soleimani, PhD, from the University of Minnesota, and colleagues argue that “dose” should not be defined solely by stimulation intensity or number of pulses, but rather as a multidimensional construct incorporating temporal spacing, cumulative exposure, and individual neurobiological factors.

This framework suggests that accelerated protocols such as SWIFT™ may represent not simply a higher or condensed dose, but a distinct mode of delivery that could engage different neuroplastic mechanisms. Temporal clustering of stimulation sessions may influence synaptic plasticity and network-level modulation differently than traditional daily spacing.

The authors also highlight substantial interindividual variability in response to TMS, emphasizing the limitations of current dosing strategies, which are largely based on motor threshold calibration.2 The lack of validated biomarkers to guide individualized treatment remains a key challenge in the field.

From a clinical perspective, this multidimensional model underscores the need for more precise characterization of how treatment parameters, including timing, frequency, and intensity, interact to influence outcomes. It also provides a theoretical basis for ongoing efforts to optimize and personalize neuromodulation therapies.

References

1. Hanlon CA, Roth Y, Bermudes RA, et al. Accelerated TMS with the H1-coil for depression: A multisite, randomized non-inferiority trial. Brain Stimulation. Published online March 2026:103050. doi:https://doi.org/10.1016/j.brs.2026.103050

2. Soleimani G, Alekseichuk I, Aurup C, et al. Dose-Response Relationships in Transcranial Brain Stimulation: Physics, Physiology and Mechanism. Brain Stimulation. Published online March 2026:103067. doi:https://doi.org/10.1016/j.brs.2026.103067

3. Radial Announces Publication of Landmark Study of Accelerated Deep TMS for Depression. Prnewswire.com. Published 2026. Accessed March 17, 2026. https://www.prnewswire.com/news-releases/radial-announces-publication-of-landmark-study-of-accelerated-deep-tms-for-depression-302712581.html

4. BrainsWay Receives FDA Clearance for Accelerated Deep TMS Protocol for Non-Invasive Treatment of Major Depressive Disorder (MDD). BrainsWay. Published 2021. Accessed March 17, 2026. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance-for-accelerated-deep-tms-protocol-for-non-invasive-treatment-of-major-depressive-disorder-mdd/