Accelerated Deep TMS for suicidal ideation could help address one of depression care’s most difficult timing problems: meaningful improvement often takes weeks, even when symptoms require prompt attention. A secondary analysis of a multisite randomized trial suggests that increasing treatment frequency may shorten the path to improvement without sacrificing overall antidepressant outcomes.
Why Treatment Speed Matters In Major Depression
Standard repetitive transcranial magnetic stimulation is typically delivered once each weekday across several weeks. The treatment uses magnetic pulses to influence brain networks involved in mood regulation and has become an established option for adults whose depression has not adequately improved with medication.
Once-daily treatment can reduce both depressive symptoms and suicidal thoughts. However, its gradual schedule may be challenging for patients who need faster symptom relief or who cannot sustain weeks of repeated clinic visits.
Accelerated protocols address this limitation by delivering several sessions per day. Rather than fundamentally changing the technology, they compress the treatment schedule and increase the density of stimulation within a shorter period.
Accelerated Deep TMS For Suicidal Ideation Compared With Standard Care
The original FDA-regulated trial randomized adults with moderate-to-severe major depressive disorder to one of two H1-coil Deep TMS schedules.
The accelerated group received intermittent theta burst stimulation five times per day across six treatment days, followed by continuation sessions. The standard group received high-frequency Deep TMS once daily according to a conventional six-week schedule.
The primary trial found that accelerated treatment was noninferior to standard treatment for depression outcomes and produced a shorter time to remission. Researchers then conducted an exploratory secondary analysis to examine whether the schedules also differed in their effects on suicidal ideation.
Multiple Measures Tracked Changes Over Time
Suicidality was assessed using the Scale for Suicide Ideation and individual suicide-related items from three established depression measures: the Hamilton Depression Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Clinically Useful Depression Outcome Scale.
Using clinician-rated and patient-reported measures allowed the researchers to examine whether the overall pattern remained consistent across different assessment methods.
At baseline, 20 of the 89 analyzed participants, or 22.5 percent, reported some suicidal ideation on the dedicated scale. By week six, that figure had fallen to six participants, or 6.7 percent.
Both treatment schedules were associated with meaningful reductions across the suicidality measures. Among participants with suicidal ideation at baseline, improvement over time was statistically significant, while differences between the two treatment groups were not significant.
The clearest distinction involved timing. A reduction of at least one point on the Scale for Suicide Ideation occurred sooner with accelerated treatment, with a reported median of 10 days.
Treatment Frequency May Influence Onset
TMS is thought to work by repeatedly modulating activity and connectivity within neural circuits involved in mood, cognitive control, and emotional regulation. The H1 coil stimulates broad areas of the prefrontal cortex, including regions connected with deeper networks implicated in depression.
Delivering multiple sessions per day may produce therapeutic effects more quickly by concentrating repeated stimulation into a shorter interval. The analysis also identified a trend suggesting that suicidal ideation could improve faster than overall depressive symptoms, particularly with the accelerated protocol.
That observation is clinically interesting because it raises the possibility that suicide-related symptoms do not always change at the same pace as the broader depressive syndrome. The study was not designed to establish an independent anti-suicidal mechanism, however, so this interpretation remains preliminary.
Important Boundaries Around The Findings
This was a secondary exploratory analysis rather than a trial designed specifically around suicidality. Participants at high risk for suicide were excluded, and only a relatively small subgroup reported suicidal ideation at baseline. The results therefore should not be generalized to people experiencing an acute suicidal crisis.
The study also included investigators with disclosed financial relationships involving the H1-coil manufacturer and other mental health companies. Independent replication will be important.
Even with these limitations, the head-to-head design offers useful evidence about treatment scheduling. Instead of comparing findings from separate accelerated and conventional studies, researchers evaluated both approaches within the same randomized multisite trial.
A More Scalable Path Toward Timely Care
The findings support continued study of accelerated Deep TMS as a way to reduce treatment burden and potentially deliver improvement sooner. Future trials should deliberately enroll and safeguard participants with varying levels of suicidal ideation, use suicidality as a primary outcome, and determine whether early gains persist after treatment.
For now, accelerated Deep TMS should be viewed as a promising scheduling strategy within structured clinical care, not a replacement for emergency assessment or comprehensive suicide prevention. Its potential value lies in making an established brain-stimulation treatment more timely and accessible while preserving careful monitoring.
Citations
Roth Y, Tendler A, Brink E, et al. Effects of H-Coil TMS on Suicidality in Major Depression: A Secondary Analysis of Data From a Multisite Randomized Trial Comparing Accelerated to Once-a-Day Stimulation. Journal of Affective Disorders. 2026.
Hanlon CA, Roth Y, Bermudes RA, et al. Accelerated TMS With the H1-Coil for Depression: A Multisite, Randomized Non-Inferiority Trial. Brain Stimulation. 2026;19(2):103050.
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