A Big Idea for a Big Problem
Over a billion people worldwide live with mental health or neurological conditions, and many don’t respond to medications alone. One treatment offering real hope is transcranial magnetic stimulation (TMS)—a non-invasive therapy that uses magnetic pulses to stimulate specific areas of the brain. But despite its promise, access to TMS remains limited due to cost, time, and logistics. What if we could scale up TMS to reach everyone who needs it?
That’s exactly the question a recent article by Dr. Jonathan Downar explores: how to make universal access to transcranial magnetic stimulation not just a dream, but a reality.
Measuring TMS Efficiency with TTPR
To understand how scalable TMS can be, Downar introduces a simple but powerful idea: treatment time per remission (TTPR). This concept measures how much clinic time is needed for each patient to achieve remission. The shorter the TTPR, the more patients a clinic can treat, and the more affordable the therapy becomes overall.
Conventional TMS protocols—especially older bilateral approaches—can take over 100 hours per remission. That’s too long to make TMS widely accessible. But newer, accelerated protocols, like theta burst stimulation (TBS) or Stanford’s SAINT protocol, may cut that number down to under 20 hours, or even less.
The Role of Personalization and Plasticity
Customizing TMS treatment to each individual can boost success rates, but it’s only helpful if it doesn’t drastically increase session time or complexity. Some strategies improve outcomes at a reasonable cost, but others may be too time-consuming to scale.
That’s where a groundbreaking idea comes in: pharmacological augmentation of neuroplasticity. Medications like D-cycloserine, when combined with TMS, may enhance the brain’s ability to change and adapt—essentially making each session more effective. This could drastically reduce the number of sessions required and push TTPR down to under 5 hours.
Could TMS Compete with Medication?
As TMS becomes more efficient, it also becomes more competitive with traditional pharmacotherapy in terms of cost. If future TMS protocols can match or beat medications in both price and effectiveness, mental health systems might begin offering TMS as a first-line treatment—not just a last resort.
This shift could be especially impactful for conditions like depression, anxiety, and OCD, where many patients don’t find relief with medications alone. The growing body of evidence supporting plasticity-augmented TMS may also attract broader insurance coverage and government investment, pushing the goal of universal access to transcranial magnetic stimulation even closer.
Moving from Possibility to Practice
The path to universal TMS access isn’t just about science—it’s about systems. Clinics will need to adopt shorter, smarter protocols. Policymakers and insurers must recognize the long-term cost savings. And continued research is needed to refine plasticity-enhancing combinations.
Still, the data is promising. With smart innovations and support from health systems, TMS may soon be as available and accessible as antidepressant medications. That’s a major step forward for patients worldwide.
Citations
- Downar J. (2025). Scaling up a success story: how do we achieve universal access to transcranial magnetic stimulation? Current Opinion in Psychiatry. https://doi.org/10.1097/YCO.0000000000001029
- Blumberger DM, Mulsant BH, Thorpe KE, et al. (2022). Effectiveness of standard sequential bilateral repetitive transcranial magnetic stimulation vs bilateral theta burst stimulation in older adults with depression. JAMA Psychiatry, 79(11), 1065–1073. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795925
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