Can Accelerated TMS Treat Depression in Just Five Days?
Yes, for many patients, though it did not clearly match the six-week course. In a UCLA review of 175 patients, the 40 who had five TMS sessions a day for five days saw depression scores (PHQ-9) fall from 17.7 to 11.0. The 135 who had the standard six weeks of daily sessions fell from 17.8 to 9.0. That difference was not statistically significant after correction. Half of the five-day patients barely improved at first, but that group saw a 36% drop in depression scores two to four weeks later.
Transcranial magnetic stimulation, or TMS, uses magnetic pulses to stimulate specific areas of the brain involved in mood. It is one of the few treatments that works for people whose depression has not improved with medication. The problem is that standard TMS requires daily clinic visits for six weeks, which is a major barrier for many patients. This new study tested whether compressing all that treatment into just five days could work just as well.
Dr. Kumar’s Take
This study adds real-world evidence to the growing case for accelerated TMS, though it was a look back at clinic records rather than a randomized trial. What stands out to me is the delayed response pattern. Some patients who did not feel better right after the five-day protocol showed a 36% improvement in depression scores weeks later. The reason is unclear, since some of those patients received extra sessions later, but a slow start did not mean the treatment had failed. For patients who struggle with the time commitment of traditional TMS, this compressed format could be a game-changer. I want to see more long-term follow-up data, but the trajectory here is very promising.
Study Design and Participants
Researchers at UCLA reviewed the records of 175 patients with treatment-resistant depression treated at their TMS clinic between 2023 and 2025. Every patient had failed at least two antidepressant treatment trials. Forty received the accelerated protocol of five sessions per day over five consecutive days (25 sessions). The other 135 received the conventional course of one session a day, five days a week, for six weeks (at least 30 sessions). Patients were not randomly assigned, and there was no sham treatment.
Results and the Delayed Response Effect
The headline finding is that the accelerated five-day protocol produced symptom relief that was not significantly different from the standard six-week treatment. The conventional group did do somewhat better on some measures: 58.5% responded by the end of treatment versus 37.5% with the five-day course, and at follow-up the conventional group had improved 57% from baseline versus 46%. Remission rates were similar (24% versus 22.5%). The delayed response effect is the most interesting part. The five-day patients in the bottom half had improved only 8% by day 5. Their depression scores dropped by 36% when they were reassessed two to four weeks after treatment ended. The reason for this later gain is unclear. Some patients with a limited early response received extra sessions (five in one day) two or more weeks after their course ended. The authors also note that conventional TMS may work better than the five-day course for some patients: improvement at follow-up was significantly greater in the conventional group (57% versus 46%).
Who Could Benefit Most
The people who stand to gain the most from accelerated TMS are those whose lives make a six-week daily commitment nearly impossible. That includes working parents, people without reliable transportation, patients who live far from a TMS clinic, and anyone whose depression makes it hard to follow through with weeks of appointments. Compressing treatment into a single work week removes many of those barriers. It also opens the door for patients who may have dismissed TMS entirely because of the time commitment.
Practical Takeaways
- Ask your psychiatrist or neurologist whether accelerated TMS protocols are available at clinics near you, as not all TMS providers currently offer the five-day format.
- If you tried standard TMS and dropped out because of scheduling, the accelerated protocol may be worth revisiting since the compressed timeline addresses a common barrier to completion.
- Do not be discouraged if you do not feel better immediately after an accelerated TMS course, because the study found significant improvement can develop over the following two to four weeks.
- Continue working with your treatment team during and after TMS, as the best outcomes typically come from combining brain stimulation with ongoing psychiatric care.
Related Studies and Research
If you are interested in learning more about TMS for depression, these articles explore related research and protocols:
- Does Daily TMS Work for Treatment-Resistant Depression?
- Accelerated TMS: Depression Treatment in 5 Days Instead of 6 Weeks
- Accelerated rTMS for Treatment-Resistant Depression
- How TMS Works: Resetting the Default Mode Network
FAQs
What is the difference between accelerated and standard TMS?
Standard TMS involves one session per day, five days a week, for about six weeks. That adds up to roughly 30 sessions spread over more than a month. The accelerated protocol in this study delivered 25 sessions, five per day over five consecutive days, so the time commitment drops from six weeks to a single week. This study found no statistically significant difference in depression relief between the two, although the six-week course had a higher response rate.
Does accelerated TMS have more side effects than standard TMS?
TMS in general is well tolerated compared to many depression treatments. The most common side effects are mild scalp discomfort and headaches during or shortly after sessions. Because accelerated TMS delivers multiple sessions in one day, patients may experience more fatigue on treatment days. However, the overall side effect profile has been similar to standard TMS in studies to date. Always discuss potential risks with your doctor before starting any TMS protocol.
Why would depression improve weeks after TMS treatment ends?
The magnetic pulses used in TMS stimulate nerve cells in brain regions that control mood. One idea is that the effects on brain circuits keep building after treatment ends, but that remains unproven. Some patients with a limited early response also received extra sessions two or more weeks after their course, which could account for part of the later improvement. The authors suggest that some slow starters might have benefited from more treatment. What the study does show is that patients in the bottom half after five days had a 36% drop in depression scores two to four weeks later.
Bottom Line
This UCLA review of 175 patients suggests that accelerated TMS, five sessions per day over five days, may work about as well as standard six-week treatment for many people. It was not randomized, and a proper trial is still needed. Patients who barely improved at first still had a 36% drop in scores weeks later, so an early lack of response did not mean the treatment failed. For the millions of people with treatment-resistant depression, this compressed protocol could make an effective treatment far more practical and accessible.
