A Transdiagnostic review of safety, efficacy, and parameter space in accelerated transcranial magnetic stimulation
Open accessAbstract
BACKGROUND: Accelerated transcranial magnetic stimulation (aTMS) is an emerging delivery schedule of repetitive TMS (rTMS). TMS is "accelerated" by applying two or more stimulation sessions within a day. This three-part review comprehensively reports the safety/tolerability, efficacy, and stimulation parameters affecting response across disorders. METHODS: We used the PubMed database to identify studies administering aTMS, which we defined as applying at least two rTMS sessions within one day. RESULTS: Our targeted literature search identified 85 aTMS studies across 18 diagnostic and healthy control groups published from July 2001 to June 2022. Excluding overlapping populations, 63 studies delivered 43,873 aTMS sessions using low frequency, high frequency, and theta burst stimulation in 1543 participants. Regarding safety, aTMS studies had similar seizure and side effect incidence rates to those reported for once daily rTMS. One seizure was reported from aTMS (0.0023% of aTMS sessions, compared with 0.0075% in once daily rTMS). The most common side effects were acute headache (28.4%), fatigue (8.6%), and scalp discomfort (8.3%), with all others under 5%. We evaluated aTMS efficacy in 23 depression studies (the condition with the most studies), finding an average response rate of 42.4% and remission rate of 28.4% (range = 0-90.5% for both). Regarding parameters, aTMS studies ranged from 2 to 10 sessions per day over 2-30 treatment days, 10-640 min between sessions, and a total of 9-104 total accelerated TMS sessions per participant (including tapering sessions). Qualitatively, response rate tends to be higher with an increasing number of sessions per day, total sessions, and total pulses. DISCUSSION: The literature to date suggests that aTMS is safe and well-tolerated across conditions. Taken together, these early studies suggest potential effectiveness even in highly treatment refractory conditions with the added potential to reduce patient burden while also expediting response time. Future studies are warranted to systematically investigate how key aTMS parameters affect treatment outcome and durability.
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The optimal inter-session interval for same-day rTMS sessions has not been systematically evaluated.
“the optimal inter-session interval for same-day rTMS sessions has not been systematically evaluated, with protocols ranging from 10 minutes to 2 hours [19]”
From A phase I trial of accelerated intermittent theta burst rTMS for amnestic MCI (2024) · cites this paper as [19]
In Results, Part 3 (page unavailable), the review says the effect of intersession interval on treatment response is unclear and cannot be disentangled from other parameters in published datasets. But Discussion, Area 3 (page unavailable), describes a study that systematically compared 0-, 10-, and 30-minute intervals using MEP changes, so saying the interval has not been systematically evaluated is too absolute. The cited 10-minute-to-2-hour range is also not the review’s reported range: it describes intervals up to 640 minutes across diagnoses. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDosing parameters vary widely across existing studies of rTMS.
“Dosing parameters (e.g., number of sessions, duration of inter-session and inter-treatment day intervals, number of active pulses, stimulation intensity, targeting method) vary widely across existing studies of rTMS [19].”
From A phase I trial of accelerated intermittent theta burst rTMS for amnestic MCI (2024) · cites this paper as [19]
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Self-citation
- Authors
- Caulfield, K. A., Fleischmann, H. H., George, M. S., & McTeague, L. M.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Caulfield, Kevin A.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 152
- Pages
- 384-396
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC10029148
- OpenAlex
- W4283642921
- Cited by
- 99
- References
- 112
- Citations by year
- 2026: 27 · 2025: 31 · 2024: 27 · 2023: 10 · 2022: 4
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Psychiatric Research (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- National Institutes of Health (F31 NRSA)
- National Institute of General Medical Sciences (P20GM109040)
- National Institute of Neurological Disorders and Stroke (F31NS126019)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD086844)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- repetitive transcranial magnetic stimulation, stimulation frequency, theta burst stimulation, low-frequency stimulation, high-frequency stimulation, depression, seizure risk, adverse effects, treatment response, patient burden
- MeSH terms
- Humans, Seizures, Treatment Outcome, Transcranial Magnetic Stimulation
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