Transcranial magnetic stimulation (TMS) was first approved for the treatment of major depressive disorder (MDD) in 2008. Because it worked well for depression by using a strong magnetic field to stimulate key brain areas, TMS was recommended early on by the American Psychiatric Association in its 2010 Practice Guidelines (APA, 2010).

TMS has on-label FDA indications including major depressive disorder in teens 15-plus and adults, obsessive-compulsive disorder (OCD), migraine headache, and for smoking cessation. TMS holds promise for other conditions (Marder et al., 2022), and potentially for wellness-related applications1, all intriguing but requiring clinical caution, good evidence, and clear ethics with any off-label uses.

Accelerated TMS protocols are of great interest, showing better results in a shorter time span than conventional four- to six-week courses, but aren't as well-understood or accessible due, as noted below, to technical requirements. A recent pilot study (Leuhr et al., 2024) looked at a series of 21 patients with severe treatment-resistant depression and treated them with a rapid TMS protocol, providing six to eight treatment sessions per day, each lasting only three and a half minutes, to deliver over 21,000 magnetic pulses in total. Importantly, no intensive techniques were required for localizing the treatment area. In this series of patients, 55% achieved a remission of depression within the initial week, and that number rose to 70%. Of those who did not fully remit, 55% experienced relief of at least half their symptoms. This is an open-label pilot study, and further research is required.

We were recently privileged to treat two patients (who provided consent to share their experience) suffering from chronic depression, suicidal thinking, and developmental and adult trauma and loss, receiving therapy and medications for many years with benefit but without full recovery, using this accelerated protocol. Both reported significant and qualitatively remarkable improvement by the beginning of the second day.

By the end of the week, they had achieved early resolution of almost all depression symptoms. While these results were in line with the pilot study, seeing it happen in real time was most remarkable. Close monitoring and ongoing psychotherapeutic support are needed to sustain and build on positive outcomes, and to determine if maintenance TMS is required.

Relief of depression lowers obstacles to growth and recovery but alone is often not sufficient. With a complicated developmental history, relational and life stressors, and years of living with depression, there is an important process of growth and recovery following successful treatment. For example, learning to differentiate normal strong reactions from depression, from........

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