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Transcranial Magnetic Stimulation (TMS) is an established, FDA-cleared treatment for major depressive disorder, including in patients with treatment-resistant depression. Advances in neuromodulation protocols, such as intermittent theta burst stimulation, have reduced session duration and improved treatment efficiency. Building on this, accelerated approaches aim to further optimize delivery by administering multiple sessions within a single day.
A retrospective analysis by Apostol et al. (2026) evaluated the clinical outcomes of an accelerated “5×5” repetitive Transcranial Magnetic Stimulation (rTMS) protocol compared with a conventional treatment approach. In the accelerated protocol, patients received five stimulation sessions per day over five consecutive days, with approximately 45-minute intervals between sessions.
Both accelerated and conventional rTMS protocols were associated with improvements in depressive symptoms. At the end of treatment, response rates were 58.5 percent for the conventional protocol and 37.5 percent for the accelerated protocol, while remission rates were 24 percent and 22.5 percent, respectively. These findings indicate that overall clinical outcomes were comparable after statistical adjustment.
Differences were observed in the temporal pattern of symptom improvement. Patients receiving the accelerated 5×5 protocol showed rapid reductions in PHQ-9 scores within the first five days, whereas those undergoing conventional rTMS experienced a more gradual improvement over several weeks.
These results suggest that accelerated rTMS protocols may enable earlier clinical response, while achieving similar overall outcomes at treatment completion. This distinction may be relevant when considering treatment timelines and patient-specific needs in clinical practice.
As a retrospective analysis, the study describes observed outcomes within a specific treatment setting and does not establish causality or definitive comparative effectiveness. Further prospective and controlled studies are needed to better define optimal dosing strategies and to evaluate long-term outcomes associated with accelerated neuromodulation protocols.
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