An accelerated five-day TMS protocol may rival the standard six-week treatment for depression.
For many people living with depression, medications do not provide enough relief. In these cases, transcranial magnetic stimulation (TMS) has become an important alternative. This noninvasive therapy uses magnetic pulses to activate targeted regions of the brain. However, the standard treatment schedule requires patients to visit a clinic every weekday for six to eight weeks, which can be challenging to maintain.
TMS is a well-established therapy for treatment-resistant depression. Large clinical studies show that it significantly reduces symptoms in 60 to 70% of patients, and 25 to 35% achieve remission. Most insurance plans cover the treatment.
Researchers at UCLA Health recently tested whether a much shorter schedule could deliver similar results. Their approach involved giving patients five sessions per day for five consecutive days, a format known as five-by-five, or “5×5.” The goal was to determine whether concentrating treatment into a single week could make TMS more practical for people who cannot commit to the traditional six-week plan.
The study, published in the Journal of Affective Disorders, included 175 patients with treatment-resistant depression. Of these, 135 received conventional TMS, consisting of one session per day, five days a week, for six weeks. The remaining 40 patients underwent the accelerated protocol, completing five sessions daily over five straight days.
Both groups experienced clear reductions in depression symptoms. Overall, the researchers found no statistically significant difference in effectiveness between the accelerated and standard schedules.
Condensing Six Weeks Into Five Days
“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.”
An important finding involved some patients in the accelerated group who showed minimal improvement immediately after completing the five-day course. When researchers reassessed them two to four weeks later, those individuals demonstrated substantial progress. On average, their depression scores had fallen by 36%.
This delayed response suggests that immediate results may not tell the full story. Patients who appear not to benefit at the end of five days may still experience significant improvement in the following weeks.
Delayed Benefits and Clinical Considerations
“All patients in this study had not benefited from multiple trials of antidepressant medication, yet they obtained great benefit from 5×5 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 5×5 can be even greater with an extra one-to-days of treatment after two weeks.”
Although the accelerated method performed similarly overall, the traditional six-week protocol remains well supported by long-term evidence. In this study, it showed stronger results on some longer-term outcome measures.
The researchers emphasized that the project was not a randomized clinical trial. Participants were not randomly assigned to each treatment group, and larger controlled studies will be necessary to confirm the findings.
Beyond refining accelerated treatment schedules, UCLA scientists are also studying TMS for additional conditions, including obsessive-compulsive disorder and chronic pain. This work reflects broader efforts to expand the role of brain-based therapies in mental health care.
Reference: “Efficacy of 5 × 5 accelerated versus conventional repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression” by Michael R. Apostol, Thomas E. Valles, Juliana Corlier, Michael K. Leuchter, Alexander S. Young, Hewa Artin, Ralph J. Koek, Evan H. Einstein, Scott A. Wilke, Hanadi A. Oughli, Thomas Strouse, Aaron Slan, Margaret G. Distler, Dustin Z. DeYoung, Nathaniel Ginder, David E. Krantz and Andrew F. Leuchter, 4 February 2026, Journal of Affective Disorders.
DOI: 10.1016/j.jad.2026.121345
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