For the many patients with depression who haven't found relief through medication, transcranial magnetic stimulation (TMS) — a noninvasive therapy that uses magnetic pulses to stimulate specific areas of the brain — has become an increasingly important treatment option. But the standard course of treatment requires daily clinic visits over six-to-eight weeks, a schedule that can be difficult for many patients to manage.
TMS is an established, increasingly important treatment option for treatment-resistant depression, and has been shown in large studies to significantly reduce symptoms in 60-70% percent of patients with 25-35% achieving remission. It is a covered benefit under most insurance plans.
New research from UCLA Health suggests that a significantly accelerated version of TMS treatment of five sessions per day over just five days (so-called five-by-five, or "5x5") may produce comparable results for many patients, potentially making the therapy accessible to people for whom the traditional schedule is a barrier.
The study , published in the Journal of Affective Disorders, compared outcomes for 175 patients with treatment-resistant depression. One group of 135 participants received conventional TMS therapy consisting of one session per day, five days a week, for six weeks. A second group of 40 participants received the accelerated protocol of five sessions per day for five consecutive days. Both groups showed meaningful reductions in depression symptoms, with no statistically significant difference in outcomes between the two approaches.
"For patients with treatment-resistant depression, getting to the clinic every weekday for at least six weeks can be a real obstacle," said study lead author Michael Apostol, a Ph.D. student at the UCLA Semel Institute for Neuroscience and Human Behavior. "What this study suggests is that we may be able to offer those same patients a path to meaningful relief in less than one week by condensing 25 TMS treatments over just five days."
One of the study's most clinically significant findings involves a subgroup of patients in the accelerated group who showed little improvement immediately after finishing their five-day course. When researchers followed up two to four weeks later, those same patients showed meaningful symptom improvement of a 36% reduction in depression scores on average.
The finding carries a practical implication for how accelerated TMS should be evaluated: a patient who appears not to have responded at the end of five days may still benefit significantly in the weeks that follow.
"All patients in this study had not benefitted from multiple trials of antidepressant medication, yet they obtained great benefit from 5x5 treatment. Some patients need to wait a few days or weeks to see benefit, and we encourage them not to give up too quickly if they don't feel better right away," said senior author Dr. Andrew Leuchter , distinguished professor and director of the TMS Service of the UCLA Department of Psychiatry and Biobehavioral Sciences. "We are finding that the benefits of 5x5 can be even greater with an extra one-to-days of treatment after two weeks."
The conventional six-week approach has a well-established track record, and the study found that it continued to outperform the accelerated approach on some longer-term measures. The authors noted this study was not a formal clinical trial with random assignment, and that larger, controlled trials will be needed to confirm these findings.
In addition to work on accelerated TMS, researchers at UCLA are exploring new indications, such as obsessive‑compulsive disorder and chronic pain, positioning TMS as a key part of the next generation of brain‑based therapies for mental health.
