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Accelerated TMS for Depression: Is aTMS More Effective than Standard TMS? (2024 Review)

Depression, a common yet severe mood disorder, affects millions worldwide, posing significant challenges in both diagnosis and treatment.

Recent advancements have led to the development of accelerated transcranial magnetic stimulation (aTMS), a novel approach aiming to offer rapid relief for individuals suffering from major depressive disorder (MDD).

This revolutionary technique has shown promising results, potentially transforming the landscape of psychiatric treatment by providing an effective, non-invasive option with the capability of sustaining long-term benefits.


  1. Rapid Symptom Improvement: aTMS can significantly decrease depression scores in a shorter period compared to standard TMS, offering hope for rapid symptom relief.
  2. Comparable Efficacy to Standard TMS: While aTMS speeds up treatment, its efficacy in reducing depressive symptoms is similar to that of conventional transcranial magnetic stimulation (TMS) methods.
  3. Potential for Long-Term Benefits: Preliminary evidence suggests aTMS not only provides immediate relief but may also have sustained effects, indicating its potential for long-term improvement in depressive symptoms.
  4. Diverse Modalities for Different Needs: Different modes of aTMS, such as accelerated repetitive transcranial magnetic stimulation (arTMS) and accelerated intermittent theta burst stimulation (aiTBS), may offer varied long-term effects, highlighting the importance of personalized treatment approaches.

Source: BMC Psychiatry (2024)

What is Accelerated Transcranial Magnetic Stimulation (aTMS)?

Accelerated Transcranial Magnetic Stimulation (aTMS) is an innovative approach to the treatment of major depressive disorder (MDD) and other psychiatric conditions.

It builds upon the foundation of traditional transcranial magnetic stimulation (TMS) by offering a condensed, more intensive treatment schedule.

Unlike standard TMS, which typically involves daily sessions over several weeks, aTMS delivers multiple sessions per day over a shorter period, aiming to produce rapid improvements in depressive symptoms.

How aTMS Works

aTMS utilizes the same fundamental technology as standard TMS.

It involves the use of a magnetic coil placed on the scalp to generate brief magnetic pulses.

These pulses induce electrical currents in the targeted brain region, specifically the dorsolateral prefrontal cortex (DLPFC), a key area implicated in depression.

The magnetic field penetrates the skull non-invasively and stimulates neural circuits within the brain, which can alter neurotransmitter levels and enhance synaptic plasticity.

This stimulation aims to correct the dysregulated neural activity associated with depression.

Mechanisms of aTMS in Depression

The mechanisms underlying the efficacy of aTMS are multifaceted, involving both neurobiological and neurophysiological changes. Key mechanisms include:

  • Neuroplasticity Enhancement: aTMS can promote synaptic plasticity, improving the brain’s ability to form and reorganize synaptic connections. This is critical for correcting the impaired neural circuits observed in depression.
  • Neurotransmitter Modulation: By stimulating specific brain regions, aTMS may influence the release and balance of neurotransmitters like serotonin, dopamine, and norepinephrine, which play vital roles in mood regulation.
  • Neural Network Activation: aTMS targets and activates neural networks that are underactive in individuals with depression, particularly those involved in mood regulation and cognitive control.

Potential Advantages of Accelerated TMS vs. Standard TMS

aTMS offers several potential advantages over standard TMS, making it an attractive option for certain patients.

  • Rapid Symptom Improvement: The accelerated nature of aTMS allows for quicker induction of therapeutic effects, which is particularly beneficial for patients with severe symptoms or those who require swift improvement.
  • Convenience & Efficiency: By condensing the treatment schedule, aTMS can reduce the overall treatment duration, offering a more efficient and potentially more convenient option for patients.
  • Potential for Enhanced Efficacy: Some research suggests that the intensive stimulation provided by aTMS could lead to more pronounced improvements in depressive symptoms, although this remains an area of ongoing investigation.
  • Flexibility in Treatment Planning: The accelerated schedule provides flexibility, allowing treatment to be tailored to individual patient needs and circumstances.

The primary appeal of aTMS lies in its potential to offer rapid relief from depressive symptoms.

For individuals who have not responded to conventional treatments, including medications and psychotherapy, aTMS presents a promising alternative.

Its ability to deliver targeted, intensive stimulation over a shorter period may also overcome limitations related to treatment adherence and the delayed onset of therapeutic effects commonly associated with standard TMS.

Accelerated TMS represents a significant advancement in the treatment of depression, leveraging the principles of neurostimulation to offer a faster, potentially more effective option for patients.

Accelerated TMS (aTMS) for Major Depressive Disorder (2024 Review)

Ruifeng Shi et al. conducted a systematic review and meta-analysis on accelerated transcranial magnetic stimulation (aTMS) for treating major depressive disorder (MDD).

They evaluated evidence on the efficacy, immediate impacts, and potential for long-term maintenance effects of aTMS.

These results are critical for understanding how aTMS compares to standard TMS and its role in future psychiatric treatment strategies.

1. Rapid Efficacy of aTMS

The meta-analysis demonstrated a significant reduction in depression scores following aTMS treatment.

The standardized mean difference (SMD) was reported at 1.80, with a 95% confidence interval (CI) of 1.31 to 2.30, and a p-value of <0.00001, indicating a strong and statistically significant improvement in depressive symptoms post-aTMS intervention.

This substantial decrease underscores the potential of aTMS as a rapid and effective treatment modality for individuals with MDD.

2. Comparison with Standard TMS

When comparing the antidepressant effectiveness of aTMS to standard TMS, the analysis found no significant difference between the two treatment methods (SMD = -0.67, 95% CI: -1.62 to 0.27, p = 0.16).

This suggests that while aTMS can accelerate the treatment process, it does not necessarily enhance the overall efficacy of TMS in reducing depressive symptoms.

This finding is crucial for clinicians considering aTMS as an alternative to conventional TMS protocols, particularly for patients requiring swift symptom relief.

3. Long-term Maintenance Effects of aTMS

The analysis highlighted the potential long-term benefits of aTMS, with depression scores at follow-up showing continued improvement beyond the immediate post-treatment period (SMD = 0.22, 95% CI: 0.06 to 0.37, p = 0.006).

This suggests that the effects of aTMS may not be transient and could offer sustained relief from depressive symptoms.

The subgroup analysis further indicated that different aTMS modalities, specifically arTMS and aiTBS, may have distinct long-term impacts. arTMS appeared to continue improving depressive symptoms after treatment, while aiTBS primarily maintained the immediate post-treatment effects.

4. Subgroup Meta-Analysis Results

The subgroup meta-analysis shed light on the nuances between the two main aTMS modalities.

  • arTMS: Showed a continuous improvement in depressive symptoms beyond the treatment period (SMD = 0.29, 95% CI: 0.10 to 0.49, p = 0.003), suggesting a potentially more durable effect of this modality.
  • aiTBS: Did not show significant differences in depressive scores from post-treatment to follow-up (SMD = 0.01, 95% CI: -0.45 to 0.47, p = 0.98), indicating that the benefits of aiTBS may plateau after the initial treatment phase.

Accelerated TMS for the Treatment of MDD: Evidence Review (2024)

The primary objective of the study was to assess the short-term efficacy and long-term maintenance effects of aTMS in patients with MDD.


  • Researchers systematically searched online databases for studies on aTMS treatment in patients with MDD published before February 2023.
  • The selection criteria included randomized controlled trials (RCTs) and before-and-after controlled studies that evaluated depressive symptoms using standardized scales before and after aTMS intervention.
  • A meta-analysis was performed on the extracted data, utilizing the standardized mean difference (SMD) to compare pre- and post-treatment depression scores.
  • Quality assessment of the included studies was conducted using the Cochrane Collaboration’s risk of bias tool, and sensitivity analysis and publication bias assessment were also performed.


  • The meta-analysis included 14 studies, comprising four RCTs and 10 before-and-after controlled studies.
  • The findings revealed significant reductions in depression scores following aTMS treatment, with no substantial difference in antidepressant effectiveness between aTMS and standard TMS.
  • Subgroup analysis indicated that different aTMS modalities might have varied long-term effects, with accelerated repetitive transcranial magnetic stimulation (arTMS) potentially continuing to improve depressive symptoms post-treatment.
  • Accelerated intermittent theta burst stimulation (aiTBS) appeared to only maintain post-treatment effects.
  • The depression scores at follow-up were lower than those immediately after the intervention, suggesting a potential long-term maintenance effect of aTMS.


  • The review highlighted several limitations, including the small number of large-scale RCTs, variability in aTMS protocols and stimulation parameters across studies, and the short duration of follow-up periods.
  • The predominance of non-RCT studies and single-blinded RCTs in the analysis, coupled with the potential placebo effect inherent in TMS treatment, posed additional challenges in interpreting the results.
  • Furthermore, the review noted the need for further research to optimize treatment protocols, identify precise localization methods for stimulation, and assess the impact of concurrent medication use on treatment outcomes.

Potential Implications of the Study on Accelerated Transcranial Magnetic Stimulation (aTMS)

The systematic review and meta-analysis of aTMS in treating major depressive disorder (MDD) has several critical implications for the field of psychiatry, patient care, and future research directions.

1. Revolutionizing Depression Treatment

  • Enhanced Treatment Efficiency: The study indicates that aTMS could significantly shorten the duration required to achieve symptomatic relief in MDD, potentially making depression treatment more accessible and efficient for patients seeking rapid improvement.
  • Alternative for Treatment-Resistant Depression: For individuals who have not responded to traditional therapies, aTMS emerges as a promising alternative, expanding the arsenal of effective treatment options for treatment-resistant depression.

2. Personalized Psychiatry Approaches

  • Tailored Treatment Protocols: The differentiation in long-term efficacy between arTMS and aiTBS underscores the importance of personalized treatment protocols. These findings advocate for the selection of aTMS modalities based on individual patient profiles, symptom severity, and specific treatment goals, paving the way for more customized therapeutic strategies.
  • Understanding Patient-Specific Mechanisms: This study’s insights into the varied responses to different aTMS protocols could encourage deeper investigation into the neurobiological mechanisms that underlie individual differences in depression. Such understanding is crucial for developing highly targeted treatments that address the specific neural deficits in each patient.

3. Stimulating Further Research & Innovation

  • Mechanisms of Action: The findings prompt further research into the precise mechanisms by which aTMS exerts its effects on the brain. Understanding these mechanisms is essential for refining aTMS protocols to maximize efficacy, minimize side effects, and potentially extend its application to other neuropsychiatric disorders.
  • Long-Term Efficacy & Safety: While the study provides initial evidence of the long-term benefits of aTMS, there is a clear need for additional research to comprehensively assess its long-term efficacy and safety. Future studies should aim to identify optimal stimulation parameters, treatment schedules, and follow-up durations to ensure sustained improvement and patient well-being.

Conclusion: aTMS for Major Depression

The systematic review and meta-analysis on accelerated transcranial magnetic stimulation (aTMS) for treating major depressive disorder (MDD) provide compelling evidence of its efficacy and the potential for sustained benefits.

This study paves the way for aTMS to become a more widely recognized and utilized treatment option, offering hope to those for whom traditional therapies have been ineffective.

The differentiation between arTMS and aiTBS modalities in terms of long-term effects highlights the importance of tailored treatment strategies in psychiatry.

As the field moves towards more personalized approaches, understanding the specific needs and neural profiles of patients will become increasingly crucial.

Further research is needed to optimize aTMS protocols, ensure long-term efficacy, and fully integrate this promising treatment into clinical practice.

Overall, this study represents a significant step forward in the ongoing quest to provide effective, rapid, and accessible treatments for depression, enhancing the quality of life for individuals affected by this challenging disorder.


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