the Difference Between
Standard v.
Accelerated TMS
What is TMS?
TMS uses a strong electromagnetic field to directly stimulate the surface of the brain with fluctuating magnetic pulses, causing neurons in that area to fire. TMS can either lead to longer-term activation, or suppression of activity in any given cortical region, depending on the type of stimulation used. The clinical effect depends on which areas of the brain are stimulated, and how they are connected with other brain areas. We have treated accelerated TMS patients off-label with excellent results, and are happy to discuss whether standard v. accelerated TMS is a better choice for you. Read more to learn more about the differences.
Focus on Major Depressive Disorder
Standard TMS
Traditional non-accelerated TMS protocols involve daily treatments, usually five days per week, for four to six weeks. Sessions are 30 to 40 minutes in length, and magnetic pulses are every 20-30 seconds with a 10 Hz (cycles per second) four-second long set of pulses. No sedation or anesthesia is required, or significant recovery time. This type of protocol works well, with remission rates over 60 percent, and corresponding high partial response rates (Marder et al., 2022). Medication is not as effective on average (Rush et al., 2006).
Accelerated TMS
An accelerated TMS protocol involves six to eight treatment sessions per day, each lasting three and a half minutes, to deliver over 21,000 magnetic pulses over the course of one week. In a recent pilot study (Leuhr et al., 2024) of 21 patients with severe treatment-resistant depression treated with a rapid TMS protocol, 55% achieved remission of depression within the initial week, and that number later rose to 70%. Of those who did not fully remit, 55% experienced relief of at least half their symptoms. This is an open-label pilot study, and further research is required to further understand this off-label treatment.
The effectiveness of TMS depends on many factors, including:
1) the total number of pulses over the whole course of treatment
2) how close together treatments are (one of the reasons accelerated works well)
If you would like to read more on which protocol may be right for you, follow the link below to learn more at Dr. Brenner’s Psychology Today blog.
Which Protocol is Best for me?
When determining which treatment course is best for you, it is important to consider a number of factors:
Time
A standard TMS course is typically 36 sessions over six to eight weeks, with each session lasting 20-40 minutes, whereas an accelerated TMS course is also 36 sessions, but it is instead done over the course of one week with six to eight three-minute sessions per day. The effectiveness of TMS is related to the total number of sessions—some people benefit from more than 36 sessions for the tratment of Major Depression.
We have found that many patients prefer the accelerated TMS course due to this shorter time frame and shorter duration of individual treatments.
Diagnosis
Accelerated TMS is FDA-cleared to treat Major Depressive Disorder (MDD), and recently, there have been promising developments in the use of accelerated TMS for the treatment of Obsessive Compulsive Disorder (OCD). In a recent study of 45 patients with OCD (Jiang et al., 2024), patients receiving accelerated TMS saw a significant decrease in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) scores.
Insurance
Standard TMS has been more easily covered by insurance, while accelerated protocols are less likely to be covered; however, this is beginning to shift.
If you would like to discuss which protocol would be the best for you, follow the link below to schedule a free consultation!