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More Rapid and More Effective Treatment for Depression, Anxiety and Other Conditions

Accelerated TMS is TMS on a rapid schedule. It is designed to include more sessions, greater precision, and more individualized treatments. Accelerated TMS is more convenient, faster acting, and shown to be more effective.

What is Accelerated TMS?

Accelerated TMS is a form of Transcranial Magnetic Stimulation (TMS) specifically designed to shorten treatment durations, improve response time, and improve results for patients. This approach involves delivering multiple treatment sessions each day for consecutive days, allowing for a more concentrated experience. Clinical evidence suggests that accelerated TMS can lead to quicker improvements in symptoms of depression, and is more likely to help patients offering a promising option for individuals seeking rapid relief.

Names and Acronyms

Transcranial Magnetic Stimulation (TMS) is a procedure that uses target magnetic pulses to stimulate neurons to treat depression, anxiety, OCD and other conditions.
Repetitive TMS (rTMS) refers to TMS where multiple treatments are administered. It is often used as shorthand to describe the conventional treatment protocol when TMS sessions are provided once a day for consecutive days for 6 to 8 weeks.
Accelerated TMS (aTMS) is a more intensive version of TMS/rTMS. It was originally developed to improve the results of TMS and typically includes a rapid and condensed schedule, more total sessions, more accurate targeting, and more individualized treatments.
Other names and acronyms associated with TMS often include Theta Burst Stimulation (TBS), Major Depressive Disorder (MDD), Treatment Resistant Depression (TRD), Treatment Resistant Generalized Anxiety Disorder (TR-GAD), Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Magnetic Resonance Imaging (MRI), and Electoencephalogram (EEG).

Background, and the SAINT or SNT Protocol

In 2022, the FDA approved an accelerated TMS protocol for depression known as the Stanford Neuromodulation Therapy (SNT) protocol, previously called the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol. This approach was developed specifically to improve the results received with TMS. It consists of five days of treatment, with 10 sessions of intermittent theta burst stimulation each day, the use of greater pulse dose of stimulation, and more targeted application of stimulation using individual MRIs paired with precision tracking equipment for coil placement.

Clinical studies have demonstrated rapid improvements in depressive symptoms among those who received this protocol. Results of limited studies show that around 90% of the patients with treatment-resistant depression met remission criteria following the accelerated TMS treatments, and testing demonstrated no negative cognitive side effects. These results are based on small sample sizes, but are about twice as good as conventional rTMS treatments!

The Stanford protocol is generally considered the foundation of modern accelerated TMS protocols. Variations and development of accelerated protocols incorporate details of clinical practice, current best practices, cost effectiveness adjustments, and other considerations. As with most medical procedures, there is variability in the accelerated protocol from provider to provider.

What Accelerated TMS Looks Like

At Wells Medicine we employ a version of accelerated TMS that relies on the best available evidence-based research and clinical practice considerations for the most-appropriate balance of effective and efficient care. We rely on strong and individualized iTBS pulse dosing, 3D position and computer guided individualized targeting, and a condensed schedule of treatment sessions. Patients typically receive a total of 50 treatment sessions over five days, with 10 sessions each day, and each session lasting 10 minutes. After each treatment, patients are given a break of 40 to 50 minutes to spend as they wish.

Treatments begin with calibration of intensity and positioning to the individual patient. For each treatment we place the electromagnetic coil and patients sit while the coil delivers targeted magnetic pulses to specific areas of the brain. For treating depression the target area is usually the dorsolateral prefrontal cortex, which is involved in mood and behavior regulation. The areas targeted and the strength of pulses can vary from patient to patient. Patients remain awake during the session, and no anesthesia or medications are required. Some may feel a slight tapping or knocking sensation on their scalp as the electromagnetic pulses are delivered but the treatments are generally minimally disruptive. Between sessions patients are free to relax, work or talk with their family as they wait. At the end of each day patients may carry on their lives as they normally would.

Benefits of Accelerated TMS

TMS offers several advantages, making it an excellent option for many candidates.

It is a non-invasive procedure that requires no surgery or anesthesia and can be performed in an outpatient setting.
TMS has few negative side effects and the common side effects typically fade rapidly.
Patients may return to their daily activities immediately after treatment.
TMS has been shown to significantly improve symptoms for many patients, including for those who have not responded to traditional treatments, such as antidepressants or psychotherapy.
TMS results can last over time – typically with the aid of maintenance treatments, and especially when paired with other helpful treatment modalities, medication management, and lifestyle modifications.

Compared to traditional TMS treatments, Accelerated TMS offers several advantages:

Fewer Treatment Days: The procedure is condensed, resulting in many fewer days of treatments than traditional TMS.
Faster Symptom Relief: Patients often experience more noticeable improvements in a shorter time frame than with standard treatments.
Convenience: The accelerated protocol makes it more suitable for individuals with busy schedules, who may not have the time for lengthy treatment durations.
Improved Effectiveness: Limited studies show accelerated TMS to be more effective than conventional courses of rTMS.

About Us

Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.

The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.

References and Resources

Cole, Eleanor J., et al. “Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression.” The American Journal of Psychiatry, vol. 177, no. 8, 2020, pp. 716–726.
https://psychiatryonline.org/doi/10.1176/appi.ajp.2019.19070720

Cole, Eleanor J., et al. “Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial.” The American Journal of Psychiatry, vol. 179, no. 2, 2022, pp. 132–141. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2021.20101429

van Rooij, Sanne J. H., et al. “Accelerated TMS – Moving Quickly into the Future of Depression Treatment.” Neuropsychopharmacology, 2023.
https://www.nature.com/articles/s41386-023-01599-z

What is accelerated TMS?