A Patient’s Guide to Accelerated TMS

If you’ve been exploring TMS therapy, you may have come across accelerated TMS (aTMS). This guide breaks down what accelerated TMS is, how it compares to other TMS protocols, what the evidence shows, and whether this approach could be suitable for you.

What is Accelerated TMS?

Transcranial magnetic stimulation (TMS) works by delivering focused magnetic pulses to specific regions of the brain. In treatment-resistant depression (TRD), the most common target is the left dorsolateral prefrontal cortex (DLPFC), a region involved in mood regulation that tends to show reduced activity in people with depression. The magnetic pulses stimulate neural activity in that area, gradually producing changes in connectivity and function over a treatment course.

Repetitive TMS (rTMS) is the most well-researched form of TMS. It involves consistent sessions of TMS over a period of around six weeks. It has been FDA approved to treat depression and other conditions since 2008.

Accelerated TMS emerged later/ Researchers began studying whether the neurological benefits of TMS could be achieved in a smaller space of time by delivering sessions closer together. Clinical trials showed positive results, the FDA have since approved specific aTMS protocols for severe depression.

The SAINT™/SAINT-style approach, which uses MRI-guided targeting, received FDA clearance in 2022 for refractory depression, and BrainsWay received clearance for an accelerated deep TMS protocol in 2025.

How Accelerated TMS Differs From Standard Repetitive TMS

Repetitive TMS remains the most thoroughly studied form of TMS therapy. Decades of clinical trials have established its safety profile and confirmed its effectiveness across thousands of patients. When clinicians talk about “evidence-based TMS,” rTMS is still the benchmark.

However, aTMS can offer faster results, which is particularly important for patients experiencing severe distress in need of rapid relief.

Here’s how the two protocols differ:

Session frequency: Standard rTMS delivers one session per day, whereas accelerated protocols typically deliver two to five sessions per day, with inter-session intervals ranging from 15 minutes to several hours.

Total treatment duration: A standard rTMS course runs 20–30 sessions over four to six weeks. Accelerated courses often deliver the same total number of sessions. However, the sessions are compressed into 5–10 days.

Stimulation protocol: Many accelerated programs use intermittent theta burst stimulation (iTBS) rather than conventional 10 Hz rTMS. iTBS delivers bursts of high-frequency pulses, achieving comparable neural effects in a three-minute session versus the 20–40 minutes of a standard rTMS session. This makes it logistically feasible to run multiple sessions in a single day.

Who Typically Opts for an Accelerated TMS Schedule

Clinical guidelines don’t yet designate one group of patients as ideal candidates for aTMS over rTMS, but in practice, certain situations make the accelerated approach worth considering.

Scheduling constraints: Patients who can’t realistically commit to five weekly appointments for a month or more, due to work demands, caregiving responsibilities, or geography, may find a one- to two-week intensive course far more manageable.

Urgent need for relief: For patients in significant distress who need a faster response, the compressed timeline of aTMS may offer earlier symptomatic improvement. Some research has documented meaningful reductions in depression scores within the first week of an accelerated course.

Treatment-resistant cases requiring a reset: Some patients who’ve had a partial response to standard rTMS in the past have tried accelerated protocols as a way to reinitiate response, though this is still an area of active research.

However, not everyone is a good candidate for aTMS. Patients with certain physical risk factors and those who are particularly sensitive to this type of brain stimulation, may do best with the standard protocol. At McLean NTC, we can help advise you on what protocols may be most appropriate for your condition.

What the Research Shows About the Effectiveness of ATMS

A 2025 study published assessed the outcomes of 247 patients with TRD treated in a hospital in Quebec, Canada. After a course of treatment, 46.3% of the patients had a significant reduction in symptoms and 36.1% achieved remission. The researchers showed there was no difference in outcomes when patients were treated with different coil types.

Another study assessed the outcomes of TRD patients treated with either aTMS or rTMS at a clinic in Camberwell. At eight-weeks following treatment, 25.4% of the aTMS group had significantly reduced symptoms and 16.9% were in remission. There were slightly better outcomes in the rTMS group, with a significant response in 29.8% of patients and remission in 17.5%.

Beyond depression, researchers have begun investigating aTMS for other conditions, though this work is still in earlier stages. This includes:

• OCD: A small 2023 study found that patients with OCD showed significantly reduced scores of OCD symptoms as well as anxiety and depression following a treatment course of aTMS.
• PTSD: In a 2025 study, aTMS significantly reduced PTSD symptoms in a group of 123 veterans. Over 60% of study participants achieved remission from symptoms.

Safety: Short-Term Side Effects and What the Long-Term Data Suggests

TMS in general has a well-established safety profile.

Short-term side effects are typically mild and transient, including:

• Headache is the most commonly reported side effect, usually resolving within a few hours of a session
• Scalp discomfort or tingling at the stimulation site is common, particularly in early sessions
• Fatigue is reported by some patients, particularly in accelerated protocols where multiple sessions occur in a day
• Neck stiffness can occur depending on positioning during treatment

Comparison studies suggest that there’s no significant differences in side effects between rTMS and aTMS. However, patients treated with aTMS generally report more discomfort.

Seizure risk is the most serious potential adverse event associated with TMS, but it is rare, estimated at approximately 1 in 10,000 treatments with standard rTMS. Careful screening for seizure risk factors significantly reduces this risk.

Long-term safety is an area where standard rTMS has a clear advantage in terms of data volume; the intervention has been tracked across large patient populations for nearly two decades. However, aTMS doesn’t have that same depth of longitudinal follow-up yet.

TMS Treatment at McLean Neuropsychiatric Treatment Centre

At McLean NTC, we’ve built our practice around offering the most effective, evidence-based neuromodulation treatments available for depression. As one of Fairfax County’s leading providers of TMS therapy, our team works with each patient to determine not just whether TMS is appropriate, and which protocol is likely to serve them best.

We currently offer rTMS or the treatment of depression, as this is the most well-researched and affordable option that is widely recognized by insurance companies. However, we will be happy to advise you about other protocols.

Whether you’re exploring TMS for the first time, or are simply trying to understand your options clearly, we’re here to have that conversation with you. Get in touch with our team to find out more.