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Major Depressive Disorder · Journal article
Journal of Affective Disorders · August 21, 2026
Encouraging direction, but not yet definitive.
This exploratory secondary analysis found that both accelerated intermittent theta burst and standard high-frequency H-coil Deep TMS were associated with meaningful reductions in suicidal ideation across multiple validated scales, with the accelerated protocol showing faster onset of improvement. The findings are limited by the secondary-analysis design, lack of a non-TMS control, and absence of reported sample size or effect magnitudes for suicidality endpoints.
Exploratory secondary analysis of a multicenter, randomized, controlled trial. Patients with major depressive disorder enrolled in the parent FDA-regulated multicenter trial. Intervention: Accelerated intermittent theta burst stimulation with H1-coil Deep TMS. Compared with: Standard high-frequency Deep TMS with H1-coil. Multicenter (specific number of sites and countries not stated in this abstract).
Both accelerated and standard Deep TMS protocols achieved meaningful reductions in suicidality on all four scales (SSI, HDRS, MADRS, CUDOS) Accelerated protocol demonstrated faster onset of improvement in suicidality compared to standard protocol Trend for faster improvement in suicidality relative to overall depressive symptoms, especially with accelerated protocol
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
These findings suggest that accelerated TMS protocols may provide faster reduction in suicidal ideation than standard dosing, which could be clinically relevant for acutely suicidal patients. However, the lack of a non-TMS control and secondary-analysis design warrant confirmation in prospectively designed trials before changing clinical practice.
Secondary analysis of an FDA-regulated trial showing meaningful reductions in suicidal ideation with both TMS protocols, with accelerated dosing achieving faster onset, but limited by exploratory design and lack of a non-TMS control.
As stated by the source record.
Quoted from the source exactly as published.
These findings suggest that accelerated TMS protocols may provide faster reduction in suicidal ideation than standard dosing, which could be clinically relevant for acutely suicidal patients. However, the lack of a non-TMS control and secondary-analysis design warrant confirmation in prospectively designed trials before changing clinical practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Suicide is the 10th leading cause of death in US adults. Standard once-daily repetitive transcranial magnetic stimulation (rTMS) can reduce suicidal ideation. Yet, antidepressant and anti-suicidal effects often take several weeks to emerge, while rapid improvement is often required. Accelerated TMS has been proposed as a strategy to hasten therapeutic response. A recent FDA-regulated multicenter trial evaluated accelerated intermittent theta burst Deep TMS with the H1-coil versus standard high-frequency Deep TMS in MDD. Both groups demonstrated high remission and response rates for depression, with the accelerated protocol showing non-inferiority and a shorter time to remission. The goal of this exploratory secondary analysis was to evaluate the impact of these two H-coil TMS dosing paradigms on suicidal ideation. The Scale for Suicide Ideation (SSI), as well as suicidality items of HDRS, MADRS and CUDOS were collected and analyzed. On all scales, both accelerated and standard Deep TMS protocols were associated with meaningful reductions in suicidality. The accelerated protocol achieved a faster onset of improvement. Comparison between the timeline of improvement in suicidality and in overall depressive symptoms found a trend for faster improvement in suicidality, especially with the accelerated protocol. These findings highlight the importance of treatment frequency in determining time to clinical benefit and support the use of scalable accelerated protocols for patients requiring more rapid symptom relief.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.