Accelerated rTMS Matches Conventional Protocol in TRD, With Andrew Leuchter, MD

New data suggest that accelerated repetitive transcranial magnetic stimulation (rTMS) protocols may offer comparable efficacy to conventional treatment schedules for patients with treatment-resistant depression (TRD), while substantially reducing treatment burden.1 In an interview with HCPLive, Andrew Leuchter, MD, a professor and director of the neuromodulation division at UCLA TMS Clinical and Research Service, discussed findings from a recent retrospective analysis comparing a 5 × 5 accelerated rTMS protocol (5 sessions per day over 5 days) with standard once-daily treatment delivered over 6 weeks.

For clinicians managing TRD, the takeaway is straightforward: rTMS remains a highly effective noninvasive neuromodulation option, even among patients who have failed multiple pharmacologic trials. However, traditional delivery schedules, requiring daily clinic visits for up to 2 months, have historically limited uptake due to logistical challenges and patient burden.

“The importance of this study that we just published is that it shows that it's not necessary to have patients come in daily for 6 or 8 weeks, that we can actually compress the entire course of TMS treatment down to just 1week, with giving patients multiple treatment sessions per day, and that this accelerated TMS treatment can be as effective or more effective than the traditional one's daily treatment,” Leuchter said.

The study evaluated 175 patients with major depressive disorder (MDD), comparing outcomes between 40 patients treated with accelerated 5 × 5 protocols and 135 patients receiving conventional once-daily rTMS. Both approaches produced significant improvements in depressive symptoms, with no statistically significant difference in overall efficacy (P =.07). Mean PHQ-9 scores decreased from 17.68 to 10.98 in the accelerated group and from 17.83 to 8.97 in the conventional group at treatment completion.

From a practical standpoint, accelerated rTMS offers a compelling advantage in terms of access and adherence. Compressing a full course of treatment into a single week may reduce disruptions to work, caregiving responsibilities, and daily functioning, which are factors that often contribute to nonadherence in conventional protocols.

However, financial considerations remain a critical barrier. Conventional once-daily rTMS is widely covered by insurance, whereas accelerated protocols are typically not reimbursed, requiring out-of-pocket payment. As Leuchter noted, this creates a clear tradeoff: accelerated treatment may be more feasible from a time perspective but less accessible from a cost standpoint.

Another clinically relevant finding from the study relates to the timing of treatment response. While some patients undergoing accelerated rTMS experienced rapid improvement within the 5-day treatment window, a substantial subset showed minimal early response. Follow-up data demonstrated that many of these initial non-responders achieved significant symptom improvement within 2 to 4 weeks post-treatment. Among the lower-response subgroup, improvement increased from 8% at day 5 to 36% at follow-up (P =.001).

“Going into treatment, this is something I tell all our patients. I say, ‘At the end of 5 days, I'm going to talk with you. We'll see how you're doing. If you're not feeling [the] benefit, don't be disappointed. I'll talk to you again in 2 weeks, and at that point, the benefits will almost certainly have started to kick in,” Leuchter said. “It's important to let patients know that upfront to temper their expectations on how quickly they’re going to recover.”

Another Recent Study on Accelerated TMS

Accelerated deep TMS has also gained attention recently. On March 17, 2026, Radial announced that a study found accelerated deep TMS, delivered over 6 days, achieved clinically comparable outcomes to standard multi-week treatment in patients with MDD.2 The SWIFT protocol cut sessions from 36 to 6 half-days.

Participants in the SWIFT arm received 5 ACC-iTBS (110% rMT, H1 coil) sessions per day for 6 days, plus 1 day per week with 2 sessions for 4 weeks. Accelerated and standard sessions yielded comparable response rates (87.8% vs 87.5%).

“Deep TMS is another form of TMS that uses a much larger electromagnet... It stimulates a much larger area of the brain surface, and it looks like deep TMS can be very effective for many patients,” Leuchter said. “There have been a few head-to-head studies, and both conventional TMS and deep TMS seem to work very well for the great majority of patients; there does not appear to be a lot of difference in effectiveness between the two types of stimulation. Some patients may do better with one or the other.”

A reported disclosure for Leuchter includes Abbott Laboratories.

References

1. Apostol MR, Valles TE, Corlier J, et al. Efficacy of 5 × 5 accelerated versus conventional repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression. J Affect Disord. 2026;403:121345. doi:10.1016/j.jad.2026.121345

2. Derman C. Accelerated Deep TMS Matches Standard Outcomes in TRD in 6 Days. HCPLive. Published March 18, 2026. Accessed on March 18, 2026. https://www.hcplive.com/view/accelerated-deep-tms-matches-standard-outcomes-trd-6-days