Real world efficacy and safety of various accelerated deep TMS protocols for major depression - BrainsWay

Real world efficacy and safety of various accelerated deep TMS protocols for major depression

Journal: Psychiatry Research (Oct 2023)

Authors: Yiftach Roth, Colleen A Hanlon, Gaby Pell, Samuel Zibman, Tal Harmelech, Owen S Muir, Carlene MacMillan, Tim Prestley, David C Purselle, Thomas Knightly, Aron Tendler


There is a growing interest in accelerated dosing regimens for repetitive transcranial magnetic stimulation (rTMS), involving multiple daily sessions. This Phase IV study assessed the safety, efficacy, and lasting effects of various accelerated protocols of Deep Transcranial Magnetic Stimulation (Deep TMS) applied in clinical settings.


Data were compiled from 111 patients diagnosed with major depressive disorder (MDD) across four sites. Patients underwent different accelerated Deep TMS protocols (2 sessions/day, 3 sessions/day, 5 sessions/day, 10 sessions/day). Self-assessment questionnaires (PHQ-9, BDI-II) and clinician-based rating scales (HDRS-21, MADRS) were administered.


On average, accelerated TMS resulted in an 80.2% response rate and a 50.5% remission rate in the first month, based on the most applicable scale for each patient. Notably, there was no significant difference between protocols (Response: 2 sessions/day: 89.6%; 3 sessions/day: 75%; 5 sessions/day: 81%; 10 sessions/day: 67.6%). Response typically occurred after 10 sessions (3 sessions/day), 20 sessions (5 sessions/day), and 31 sessions (10 sessions/day), all within the initial 3-4 days of treatment. For patients with longer-term follow-up, durability was observed in 86.7% (n = 30; 60 days) and 92.9% (n = 14; 180 days). The protocols were well-tolerated, with no reported serious adverse events.


Accelerated Deep TMS protocols are deemed safe and effective therapeutic choices for MDD, providing a rapid onset of action and prolonged durability for treatment-resistant patients.

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