Accelerated TMS – FAQs

Accelerated TMS is a treatment that delivers multiple TMS sessions in one day in order to both lessen the logistical burden on patients to complete a full TMS course (time and distance to clinic) as well as potentially shorten the time to TMS treatment response. Accelerated TMS is still considered experimental and is not currently FDA approved, although research is ongoing, and the evidence base for its use clinically continues to grow.

There is no current set “standard” for how many TMS treatments in one day is optimal. Existing evidence supports protocols ranging from 2 to 10 treatments per day (for a total of 30 treatments), although more research is needed to fully compare across treatment frequencies and protocols. Each individual treatment lasts 3 to 6 minutes of actual stimulation time.

Great question! As the standard for most Accelerated TMS protocols is 30 treatments, total treatment course duration is determined by how many treatments per day are delivered. For example, an Accelerated TMS course of 2 treatments/day will last 15 days (3 weeks for 30 total treatments), whereas an accelerated course of 10 treatments/day will only last 3 days (for a total of 30 treatments).

As there is no set optimal accelerated protocol, determining the right number of treatments per day  for a specific patient depends on several factors:

1. Total treatment course time: More treatments/day will result in a shortened TMS course time. What are the time and distance limitations of the patient? How many days do they have to dedicate to attending clinic to complete TMS?

2. Time in clinic: It is important to note that patients must wait 30 minutes between each accelerated treatment in order for the brain to absorb the stimulation and start to make new connections. As a result, treatments are delivered on an hourly basis. Therefore, a “more accelerated” protocol (e.g. 10 treatments/day), while only lasting 3 days, would require a 10-hour in-clinic commitment on those 3 days. Conversely, a “less accelerated” protocol (e.g. 2 treatments/day), lasting 15 days total, would only require 2 hours in clinic on a treatment day. Choosing the correct accelerated protocol is largely a discussion with the patient around the tradeoff of how many days they want to come in versus how long they are able to be in clinic on any treatment day.

3. Time to response and efficacy: While this continues to be an active area of research, it is possible that more accelerated protocols may achieve faster response rates and/or better efficacy than less accelerated protocols, but again more research is needed to fully determine the extent to which this is the case.

We have found that it’s convenient for many patients to complete the full 30-treatment course in 5 days (generally a Monday to Friday commitment), so our most commonly recommended protocol is 6 treatments/day for 5 days and 6 hours total in clinic on each treatment day.

For patients for whom the 6-hour in-clinic time commitment is too high, we have also had success with 3 treatments/day for 10 days (2 weeks total) and 3 hours in clinic on each treatment day.

Lastly, these above protocols are off-label and therefore cash-pay in most cases. For patients with Medicare and other insurance currently covering 2 treatments/day, we have also had patients elect for 2 treatments/day for 15 days (3 weeks) on an in-network basis (payor dependent).

A recent exciting real-world study conducted by Brainsway compared providing TMS treatments 2x, 3x, 5x, or 10x per day for a total of 30 treatments¹. Treatment course durations varied from 3 to 10 days. All accelerated protocols showed statistically similar benefits: 80% response and 50% remission rates with clinically significant benefits notable by day 3 of treatment in all cases. These findings show that patients can start to feel relief of their depressive symptoms within days of treatment initiation, a significant improvement over the time course of standard, daily treatment which generally takes 2-3 weeks to see similar effects.

At Mindful Health Solutions, our own real-world outcomes data aligns with the Brainsway study. Analysis of our outcomes – mostly 30 treatments in 5 days as well as some 3 days/week courses as well:

• 82% of patients experienced clinical improvement (at least 5-point improvement in PHQ-9)
• 65% of patients experienced a 50% reduction in symptoms (as measured by PHQ-9 or MADRS)
• 50% of patients experienced total remission of symptoms (as measured by PHQ-9 or MADRS)

These outcomes were measured at the end of the course (5 to 10 days after treatment start depending on treatment protocol).