Medically Reviewed By Ziv E. Cohen, M.D., Medical Director
November 7, 2022
For someone living with depression, six weeks can feel like a long time. Conventional transcranial magnetic stimulation, or TMS, generally involves weekday appointments over several weeks. It is an established treatment, but the schedule can be difficult to manage alongside work, family, and the burden of depression itself.
Accelerated TMS brings multiple treatment sessions into a single day, shortening the overall course. Depending on the protocol, treatment may be completed over three weeks or in as little as five days.
I have provided TMS since 2008, when the first TMS device entered the U.S. market for depression treatment, and I was one of the first providers at Weill Cornell to be trained in it. Since then, the field has advanced considerably. The important question is how to use those advances thoughtfully: which treatment, for which patient, and with what evidence?
TMS uses magnetic pulses delivered through a coil placed against the scalp to stimulate brain circuits involved in depression. Patients remain awake, and treatment does not require anesthesia.
“Accelerated” describes the schedule: more than one session per day. It does not identify a single treatment. Accelerated protocols differ in the stimulation pattern, number of pulses, sessions per day, breaks between sessions, and targeting method.
These details matter. Two treatments can both be called accelerated TMS without being identical or having the same supporting evidence.
At Principium Psychiatry, we offer a range of accelerated TMS protocols, including three-week courses and intensive 5-day TMS options. The recommendation follows a psychiatric evaluation rather than a standard schedule applied to everyone. You can learn more about our overall approach on our TMS treatment page.
Intermittent theta-burst stimulation, or iTBS, delivers magnetic pulses in brief bursts. It allows stimulation to be delivered more quickly than many conventional TMS sessions.
The landmark THREE-D trial randomized 414 patients with treatment-resistant depression. A three-minute iTBS session was as effective as a conventional session lasting approximately 37 minutes. Importantly, this was a study of once-daily treatment, not a five-day accelerated course. It established an important foundation for subsequent research. Read the THREE-D study on PubMed.
Accelerated protocols can use longer theta-burst sessions and different doses. A short stimulation session also does not mean a short treatment day: scheduled intervals between sessions are part of the protocol.
The evidence supports accelerated TMS as a meaningful treatment option, while also showing why we must pay attention to the protocol studied.
Three sessions per day. A 2025 randomized, sham-controlled trial in JAMA Psychiatry enrolled 100 adults with treatment-resistant depression. Treatment used a MagVenture system, three theta-burst sessions per day over three weeks, and scalp-based targeting without MRI. At five weeks, average depression severity had fallen approximately 55% with active treatment versus 32% with sham treatment, and remission rates were roughly 34% versus 16%. Read the study on PubMed.
Five sessions per day. A 2026 UCLA study compared 40 patients receiving five sessions daily for five days with 135 receiving conventional once-daily treatment. Both groups improved, without a statistically significant difference in symptom change at treatment completion. Some accelerated-treatment patients continued improving during the following two to four weeks. This was a retrospective study using MagVenture and Magstim equipment, rather than a randomized trial proving equivalence. Read the study on PubMed.
The broader evidence. A 2026 meta-analysis of 15 randomized trials involving 704 patients found accelerated iTBS superior to sham treatment. The studies used different protocols, so their combined results should not be presented as the expected outcome of every accelerated schedule. Read the analysis on PubMed.
In May 2026, the FDA cleared the MagVenture Accelerated TMS Therapy System for specified accelerated treatment schedules in adults with major depressive disorder who have not improved satisfactorily with antidepressant medication in the current episode.
The clearance includes an iTBS schedule of ten sessions daily for five days. It permits standard scalp-based targeting; MRI guidance is optional. The clearance applies to the specified system and treatment parameters, rather than automatically covering every device or accelerated schedule. View the FDA clearance documentation.
Principium uses both MagVenture and NeuroStar systems in its TMS practice, most frequently MagVenture. Our five-day accelerated treatment is delivered using MagVenture equipment.
Stanford Accelerated Intelligent Neuromodulation Therapy, or SAINT®, is a particular accelerated approach combining intensive iTBS with individualized functional MRI-based targeting. It has its own research literature and should be distinguished from accelerated TMS generally. Findings from SAINT studies should not be assumed to apply to other protocols. Principium Psychiatry has carefully selected the accelerated TMS protocols it offers. At this time, Principium does not offer SAINT or use the Magnus Medical system.
Accelerated TMS may be worth considering when depression has persisted despite treatment and a conventional appointment schedule presents difficulties.
The evaluation should address the diagnosis, previous treatments, medications, medical history, and potential contraindications. A history of mania, seizures, or implanted devices requires particular attention.
Treatment can cause scalp discomfort or headaches, and seizures are a rare but serious risk. Patients need appropriate screening, monitoring, and hearing protection. Completing treatment within a week does not guarantee remission within that week. Follow-up remains important, including when improvement develops after the course ends.
How long is each treatment day?
It depends on the protocol. On an intensive five-day course, sessions are spaced throughout the day with scheduled breaks between them, so patients should plan to spend most of the day at our office. Three-week courses involve fewer sessions per day and shorter visits.
Does insurance cover accelerated TMS?
Coverage varies by plan, and accelerated schedules are not always covered in the same way as conventional TMS. Our team can review your benefits before treatment. See our TMS insurance options for more information.
What are the side effects?
The most common are scalp discomfort at the treatment site and headache, which usually lessen over the course of treatment. Seizures are rare. Treatment does not require anesthesia, and most patients can resume normal activities between and after sessions.
When will I notice improvement?
Some patients improve during the treatment week, while others notice changes in the weeks after the course ends. We schedule follow-up to track progress and decide on next steps.
My work in interventional psychiatry includes TMS, electroconvulsive therapy, and ketamine therapies. That broader experience matters when deciding which treatment offers a particular patient the best path forward.
As founder and medical director of Principium Psychiatry, I have built our approach around careful evaluation, attentive treatment, and ongoing assessment of results. Excellence in TMS requires both technical knowledge and clinical judgment.
Patients considering accelerated TMS in NYC or Greenwich can contact Principium Psychiatry to discuss suitability, scheduling, and treatment location. Our goal is to explain the options clearly and recommend a plan grounded in the evidence and the individual patient’s needs.
This article is for educational purposes and is not medical advice. Individual results vary. Please consult a qualified clinician about your specific situation.
