TMS, or transcranial magnetic stimulation, is a pharmaceutical-free Depression treatment. Using magnetic pulses to activate specific areas of your brain where low activity causes Depression, TMS stimulates the brain in an effective, safe, nonconvulsive, and noninvasive way. But what makes accelerated TMS protocols different?
Accelerated TMS is exactly what it sounds like – a quicker, more accessible alternative to standard TMS. Applying more than one TMS treatment per day, accelerated TMS shortens the duration of the treatment course from the typical 36 sessions delivered one session per day over about an 8 week period. Read on to learn more about the benefits of different types of accelerated TMS protocols.
What Are Accelerated TMS Protocols and How Do They Work?
Transcranial magnetic stimulation treats Depression by targeting areas of low brain activity through noninvasive magnetic pulses. An extremely effective alternative to antidepressants, TMS is ideal for patients who are not adequately helped by medication or talk therapy.
Accelerated TMS describes a TMS regimen in which patients receive more than one TMS treatment per day, with some protocols involving up to ten treatment sessions every day for five days. By administering treatment sessions over a condensed timeframe, accelerated TMS delivers faster relief from depressive symptoms than standard TMS.
One 2010 study of an accelerated TMS protocol demonstrated an excellent safety profile with efficacy comparable to that achieved by standard daily TMS. Subsequent studies have also shown that the response rates of standard and accelerated TMS regimens are usually the same.
Benefits of Accelerated TMS
An accelerated TMS protocol has the same benefits as standard TMS and the same side effects, most commonly mild headaches at the beginning of the treatment course. The daily administration of TMS over a 7-8 week period can limit its availability, especially for patients who have busy schedules or who would need to travel a significant distance to access a treatment site.
Consolidating the full course of treatments can have significant advantages and can allow TMS to be used more easily in inpatient settings (although TMS is rarely done in inpatient settings at this time). Additionally, antidepressant benefits might be seen within a few days, rather than the several weeks typically needed for improvement to begin in a standard TMS course. And because TMS can be used in conjunction with other treatments for Depression, an accelerated TMS protocol can fit seamlessly into your mental healthcare regimen.
Accelerated TMS Protocols: Understanding Your Options
There are a few potential accelerated TMS protocols available today. One method uses multiple daily sessions of intermittent theta burst stimulation (iTBS). A 2010 study that delivered 20 theta burst sessions over an 8-day period to nine patients demonstrated that five of the nine patients studied experienced at least a 50% symptom reduction in the severity of their depressive symptoms.
The most noteworthy accelerated TMS protocol is Stanford Accelerated Intelligent Neuromodulation Therapy, or SAINT. SAINT is an approach to treatment-resistant Depression that delivers more pulses to the brain over a shorter amount of time to treat Depression symptoms. A study conducted by Dr. Nolan Williams on 21 hospitalized patients found that by the end of the 5th day of the study, 19 out of 21 patients were considered in remission.
The second most common accelerated TMS protocol uses conventional TMS (or rTMS) but increases the number of sessions from one a day to multiple sessions in one day. One 2018 study, for example, compared an accelerated rTMS protocol (that involved delivering 3 treatments per day the first week, 2 treatments the second week, and 1 treatment the final 3rd week) versus a standard four-week course of rTMS delivered one session per day. The accelerated protocol produced antidepressant effects that were similar to those seen with a standard four-week course of rTMS.
What Makes the SAINT Protocol Different?
The SAINT protocol (Stanford Accelerated Intelligent Neuromodulation Therapy) is an elevated, FDA-recognized accelerated TMS method that uses iTBS delivered up to 50 times over five days, with precision targeting guided by fMRI and neuronavigation. It has boasted remarkably high response and remission rates, with up to 85–90% immediate response and approximately 60% of patients maintaining remission a month later.
Why SAINT May Not Be Right for Everyone
Accelerated protocols have shown incredible early results. However, SAINT comes with critical drawbacks that patients should consider, including a dependence on having a patient be in office for treatments 10 hours a day for 5 consecutive days and on expensive fMRI-guided neuronavigation limits accessibility.
The cost can run from $30,000 to $36,000 or more depending on the provider, creating a significant barrier for many patients. The protocol requires fMRI scans and neuronavigation, both of which are time-consuming and expensive. Additionally, SAINT is based on proprietary targeting systems that are less transparent and harder to adapt to individual clinic workflows.
Unlike SAINT, which mandates costly fMRI-guided targeting, we rely on clinician-guided anatomical localization and proven iTBS delivery at 120% motor threshold, as demonstrated effective in Luehr’s protocol. Our approach is cost-effective and practical, eliminating high-tech infrastructure to reduce treatment cost and complexity, making it ideal for broader access and insurance compatibility.
We avoid prohibitive costs and infrastructure by eliminating the need for lengthy fMRI scans or software licensing, instead leveraging accurate methods of coil placement that give you access to accelerated treatment without extreme pricing. Our approach is accessible and practical, built around your life rather than an institution’s budget.
Clinical Foundations: The Luehr et al. (2024) Study
A pilot study by J. G. Luehr and colleagues (2024) demonstrated that a pragmatic, five-day accelerated TMS protocol is both feasible and safe, delivering remarkable antidepressant effects within a compact timeframe without needing the costly infrastructure of the SAINT approach. This research opens the door to making rapid TMS treatment available to more patients who need it.
The Luehr Study Methodology of a 5-Day Accelerated TMS Protocol
Published in Brain Stimulation, Luehr and colleagues described a 5-day accelerated iTBS-based protocol delivered via two to five sessions daily over five consecutive days, with clinical assessments conducted daily. The study evaluated safety, efficacy, and feasibility when applying this approach in real-world clinical settings.
The study involved 20 adult patients at two Swedish public brain stimulation centers (Lund and Helsingborg) with moderate to severe Depression (MADRS ≥ 20). After screening for common contraindications such as neurological issues, metal implants, and seizure risk, the participants received treatment in a structured but pragmatic clinical workflow.
Regarding treatment design and delivery, the protocol delivered 60 cycles of 10 bursts at 50 Hz, in trains at 5 Hz with an 8-second intertrain interval. The schedule consisted of 5 sessions on Day 1 (to accommodate setup and motor threshold titration), followed by 7 sessions daily on Days 2 through 5. Each session delivered 1,800 pulses at 120% motor threshold, targeting the left dorsolateral prefrontal cortex (DLPFC). The intersession interval was 50 minutes, with a 110-minute lunch break before the fifth session.
In terms of safety and tolerability, all 20 patients reported at least one adverse event, with headaches being the most common (18 out of 20 patients), followed by muscle twitching, anxiety, and dizziness. These adverse events were generally transient and mild, measured via VAS (0 = worst, 10 = no side effects). The pretreatment VAS mean was approximately 7.5, with post-treatment scores around 7.6 and 30-day follow-up scores increasing to approximately 8.4 (ITT) and 8.7 (per-protocol). Memory function (CPRS-M) remained stable from baseline (2.2) to follow-up (1.7), indicating negligible cognitive impact.
The efficacy outcomes were encouraging. Among the 18 patients completing per-protocol, MADRS scores dropped from 28.6 at baseline to 19.3 post-treatment, representing a 31.8% reduction that was statistically significant (p = 0.003). The response rate (defined as at least 50% reduction in severity of symptoms) was 28% (5 out of 18 patients), and the remission rate (MADRS less than 11) was 17% (3 out of 18 patients). Follow-up analyses found a modest positive correlation (r = 0.39) between patients’ pretreatment expectations and MADRS improvement, suggesting that mindset may play a role in treatment outcomes.
Broader Research Support
Broader reviews of accelerated TMS, such as van Rooij et al. in Neuropsychopharmacology (2024), highlight that accelerated protocols generally match or even outperform standard TMS in both efficacy and safety while dramatically shortening treatment timelines. While SAINT shows impressive numbers, other studies stress that much of that benefit likely stems from increased dosage speed rather than primarilyp the exclusivity of the targeting method. This finding has important implications for patients seeking effective treatment without the high costs associated with specialized imaging equipment.
Comparing Key TMS Protocols at a Glance
| Feature | SAINT Protocol | Luehr et al. Pragmatic Accelerated TMS | Mid City TMS Tailored Protocol |
| Duration | 5 days, 10 sessions/day | 5 days, 5–7 sessions/day | 5-10 days, 3-7 sessions/day |
| Total Pulses | ~90,000 | ~31,500 (1,800 x ~18 sessions) | Similar to Luehr |
| Targeting Method | fMRI-guided neuronavigation | MRI-guided with anatomical landmarks | clinician-based targeting using BEAM method |
| Response Rate | Up to 90% remission | 28% response, 17% remission | 70-80 % response, 30-40 % remission |
| Tolerability | Good, some headaches | Mild-to-moderate AEs, no seizures | same as Luehr’s outcomes |
| Cost & Accessibility | High cost, limited access | Moderate resources needed | Accessible & often insurance-aligned |
| Practical Implementation | Specialized setup & training | Intensive schedule, staffing |
What Patients Can Expect for Accelerated TMS Protocols at Mid City TMS
Your journey begins with a consultation and screening, including a clinical assessment and safety screening by Dr. Bryan Bruno following inclusion and exclusion criteria similar to those used in the Luehr study. From there, we develop a personalized iTBS plan with a schedule spanning 5 to 10 days in an accelerated block. You will receive 3 to 7 sessions daily, with each session delivering 1,800 pulses at 120% motor threshold to the left DLPFC.
During treatment delivery, sessions are carefully spaced with built-in breaks. We conduct cognitive check-ups including memory ratings, Depression ratings, and wellbeing scales, along with regular follow-ups with Dr. Bruno. After treatment is complete, we provide post-treatment follow-up to discuss maintenance strategies or standard iTBS if warranted.
Why Accessibility Matters for Your Recovery
SAINT’s high remission claims are impressive, but its resource intensity makes it out of reach for most clinics and patients. The Luehr et al. study proves that rapid, effective, affordable accelerated TMS is feasible without sacrificing clinical rigor.
At Mid City TMS, our tailored protocol emphasizes real-world applicability over research exclusivity, delivers measurable benefits shown in peer-reviewed data, and maintains patient comfort, safety, and affordability throughout the treatment process.
Contact Mid City TMS for Accelerated TMS Therapy
Transcranial magnetic stimulation is an effective alternative to traditional Depression treatments. Eliminating the potential harmful side effects of pharmaceuticals and speeding up the long recovery timeline associated with talk therapy, TMS helps patients feel better faster. Accelerated TMS protocols maximize this quick turnaround, making it more accessible for people who prefer or need a briefer course of treatment.
The Luehr et al. (2024) pilot study illuminates a path toward rapid, effective, and scalable accelerated TMS without requiring high-cost imaging and impractical scheduling. With similar methods, Mid City TMS offers responsible innovation: accelerated protocols grounded in clinical evidence and shaped for real patients.
Rapid antidepressant effects should not be confined to high-budget centers. With our tailored accelerated iTBS protocols, we bring hope quickly, affordably, and compassionately. We offer a variety of transcranial magnetic stimulation treatment protocols, including accelerated TMS protocols, all of which are noninvasive, electromagnetic treatments for Depression. To learn more about TMS and whether it could be the right treatment for you, contact us today for a free consultation.
Sources
- Holtzheimer, P. E. III, McDonald, W. M., Mufti, M., Kelley, M. E., Quinn, S., Corso, G., & Epstein, C. M. Accelerated repetitive transcranial magnetic stimulation (aTMS) for treatment-resistant depression. Depression and Anxiety. 2010;27(10):960–963. https://doi.org/10.1002/da.20731 https://pmc.ncbi.nlm.nih.gov/articles/PMC3020591/
- Bröcker, E., Van den Heuvel, L., & Seedat, S. Accelerated theta-burst repetitive transcranial magnetic stimulation for depression. South African Journal of Psychiatry. 2019;25:1346. https://doi.org/10.4102/sajpsychiatry.v25i0.1346 https://pmc.ncbi.nlm.nih.gov/articles/PMC6890565/
- Luehr, J. G., Fritz, E., Turner, M., Schupp, C., & Sackeim, H. A. Accelerated transcranial magnetic stimulation: a pilot study of safety and efficacy using a pragmatic protocol. Brain Stimulation. 2024;17(4):860–863. https://doi.org/10.1016/j.brs.2024.07.009 https://pubmed.ncbi.nlm.nih.gov/39033852/
- Baeken, C., Le Reste, P. J., … [Authors as listed in PMCID record] [Title verified from PMC]. Frontiers in Psychiatry. 2018;9:424. https://pmc.ncbi.nlm.nih.gov/articles/PMC6220029/
- Morriss, R., Briley, P. M., Webster, L., Abdelghani, M., Barber, S., Bates, P., Brookes, C., Hall, B., Ingram, L., Kurkar, M., Lankappa, S., Liddle, P. F., McAllister-Williams, R. H., O’Neil-Kerr, A., Pszczolkowski, S., Suazo Di Paola, A., Walters, Y., & Auer, D. P. Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nature Medicine. 2024;30(2):403–413. https://doi.org/10.1038/s41591-023-02764-z https://pmc.ncbi.nlm.nih.gov/articles/PMC10878976/
- Camacho-Conde, J. A., Gonzalez-Bermudez, M. R., Carretero-Rey, M., & Khan, Z. U. Brain stimulation: a therapeutic approach for the treatment of neurological disorders. CNS Neuroscience & Therapeutics. 2022;28(1):5–18. https://doi.org/10.1111/cns.13769 https://pmc.ncbi.nlm.nih.gov/articles/PMC8673710/
- Fitzgerald, P. B., Hoy, K. E., Elliot, D., McQueen, R. N. S., Wambeek, L. E., & Daskalakis, Z. J. Accelerated repetitive transcranial magnetic stimulation in major depressive disorder. Neuropsychopharmacology. 2018;43(7):1565–1572. https://doi.org/10.1038/s41386-018-0009-9 https://pmc.ncbi.nlm.nih.gov/articles/PMC5983543/