The availability of an accelerated TMS protocol has the potential to achieve the therapeutic outcomes of TMS in a shorter time. This could be particularly useful by making the benefits of TMS available to people who are unable to attend several weeks of treatment sessions.
In February 2022, we published a blog post that introduced the topic of accelerated TMS. Ongoing research has continued to produce insights into the effectiveness and safety of accelerated TMS for faster symptom relief since that time. Additionally, since the publication of that initial blog post, the FDA approved the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol for treatment-resistant Depression. Now, a new multisite randomized trial from 2026 provides some of the most comprehensive evidence yet on how accelerated TMS for faster symptom relief compares to standard TMS — particularly from the patient’s perspective. Here is what the research tells us.
What Is Accelerated TMS?
Traditional TMS is delivered once daily, five days per week, over a period of six to eight weeks. While effective, this schedule can be difficult for many patients due to work, childcare, transportation, or other commitments.
Accelerated TMS for faster symptom relief address these challenges by condensing multiple treatment sessions into a shorter time frame, potentially delivering faster results without sacrificing effectiveness. Instead of attending daily appointments across several weeks, patients may complete an equivalent course of treatment in a fraction of the time.
A New Multisite Randomized Trial (2026)
A newly published multisite randomized trial reviewed by Nguyen et al. (2026) and conducted by Tendler and colleagues provides important new insights by directly comparing an accelerated TMS protocol with the standard once-daily approach. What makes this study particularly valuable is its focus on patient-reported outcomes (PROs) — how patients themselves experience changes in mood, anxiety, and quality of life.
Key study details:
- Participants: 104 adults with moderate-to-severe major depressive disorder (MDD)
- Age range: 22–86 years
- Sites: 7 in the United States, 1 in India
- Inclusion criteria: Failure of one to four antidepressant trials, stable medication regimen for at least two months, and significant depressive symptoms
Participants were randomized into two groups to compare accelerated TMS vs standard TMS:
Accelerated TMS — 5 sessions per day over 6 days, followed by a 4-week continuation phase of twice-weekly sessions. Total: 38 sessions across 10 visit days.
Standard TMS — 1 session per day, 5 days per week for 4 weeks, followed by a 2-week continuation phase. Total: 24 sessions across 24 visit days.
What the Study Found
At the end of six weeks, both treatment approaches produced remarkably similar outcomes.
- Depression response rates: Accelerated 70.0% vs. Standard 75.6%
- Depression remission rates: Accelerated 57.5% vs. Standard 58.5%
- Quality of life: Improved from roughly 38% at baseline to approximately 70% after treatment in both groups
There were no statistically significant differences between the two groups in overall outcomes.
The Most Important Difference: Speed of Improvement
While overall effectiveness was similar, one finding stood out clearly: the median time to depression response was 11 days for accelerated TMS compared to 16 days for standard TMS — a statistically significant difference.
For patients with moderate-to-severe Depression, even a few days can make a meaningful difference, especially when symptoms include low motivation, impaired functioning, hopelessness, or difficulty engaging in daily life. Faster symptom relief can help patients return to their normal routines more quickly and may also improve adherence to the full course of treatment.
Safety
No serious adverse events occurred in either group. This reinforces what research has consistently shown: TMS is a safe and well-tolerated treatment, even when delivered in an accelerated format. Common side effects, such as mild scalp discomfort or headache, are typically mild and resolve quickly.
Earlier Research on Accelerated TMS vs Standard TMS
The 2026 trial builds on a growing body of literature. Three earlier studies established important groundwork:
A comprehensive literature review (Caulfield et al., Journal of Psychiatric Research, August 2022) analyzed multiple studies and concluded that accelerated TMS safety is comparable to once-daily TMS, with an average response rate of 42.4% and remission rate of 28.4% across reviewed studies. The authors also highlighted the need for further research on optimal parameters, including the number of sessions per day and the interval between sessions.
A comparison of accelerated TMS protocols (van Rooij et al., Neuropsychopharmacology, May 2023) examined variability across accelerated protocols and identified nine key elements — such as stimulation frequency, number of treatment days, and individualized dosing — that may affect outcomes. The authors called for additional research while noting that cost and equitable access should remain considerations as accelerated TMS develops.
A comparison of accelerated TMS and esketamine nasal spray (Pettorruso et al., Brain Stimulation, July 2023) suggested that accelerated TMS worked faster than Spravato (esketamine) based on response rates at a one-month follow-up, with comparable response rates at three months. Accelerated TMS also showed a lower risk of treatment-related side effects.
What Accelerated TMS for Faster Symptom Relief Means for Patients
Taken together, the research indicates that accelerated TMS can offer:
- Comparable overall effectiveness to standard TMS
- Faster symptom relief, with patients potentially beginning to feel better within 11 days rather than 16
- A significantly shorter treatment schedule, which may be especially valuable for patients who face logistical barriers to attending daily sessions over many weeks
- A strong safety profile, consistent with what has been established for standard TMS
It is worth noting that accelerated TMS for faster symptom relief protocols can vary considerably in their parameters, and research is ongoing to determine the optimal approach. The 2026 multisite trial represents an important step forward, but it is not the final word — further studies will continue to refine our understanding of who benefits most and how treatment should be structured.
Is Accelerated TMS for Faster Symptom Relief Right for You?
There are many treatment options for Depression, and the right approach depends on your specific situation, history, and needs. Accelerated TMS, standard TMS, Spravato (esketamine), and antidepressant medications are all among the treatments available at Mid City TMS. Dr. Bruno and our team are happy to consult with you to determine what approach makes the most sense for you.
Contact us today to learn how Mid City TMS can help, or read our blog for more on Depression treatments and the latest research.
Sources
- Tendler, Aron, et al. “Patient-Reported Outcomes Following Accelerated vs. Standard TMS with the H1 Coil for Major Depression: A Multisite Randomized Trial.” Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, vol. 19, 2026.
- Caulfield, Kevin A., et al. “A Transdiagnostic Review of Safety, Efficacy, and Parameter Space in Accelerated Transcranial Magnetic Stimulation.” Journal of Psychiatric Research, vol. 152, 2022, pp. 384–396. ISSN 0022-3956.
- van Rooij, Sanne J. H., et al. “Accelerated TMS – Moving Quickly into the Future of Depression Treatment.” Neuropsychopharmacology, vol. 49, 2024, pp. 128–137.
- Pettorruso, M., et al. “Comparing Fast-Acting Interventions for Treatment-Resistant Depression: An Explorative Study of Accelerated HF-rTMS versus Intranasal Esketamine.” Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, vol. 16, 2023, pp. 1041–1043.
