Accelerated TMS worked faster than standard TMS, not better, in four randomised and ten before-and-after studies
Depression scores fell after accelerated TMS, but against standard TMS the difference was not significant (SMD -0.67, 95% CI -1.62 to 0.27); follow-up was short and the maintenance signal is provisional.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Four randomised trials is a thin base for a head-to-head conclusion, and the null difference has a wide interval (-1.62 to 0.27) that does not rule out either direction. The maintenance signal rests on short follow-up, as the authors say.
Significant findings
Accelerated TMS compresses a course into days rather than weeks. Shi and colleagues searched for studies of accelerated TMS in major depressive disorder published before February 2023 and pooled four randomised controlled trials and ten before-and-after controlled studies, in a PROSPERO-registered review (CRD42023406590).
Depression scores fell after the intervention (standardised mean difference 1.80, 95% confidence interval 1.31 to 2.30). Against standard TMS, though, "there was no significant difference in antidepressant effectiveness" (SMD -0.67, 95% CI -1.62 to 0.27, p = 0.16). Scores at follow-up were a little lower than immediately after treatment (SMD 0.22, 0.06 to 0.37), which the authors read as "a potential long-term maintenance effect". By protocol, accelerated rTMS showed continued improvement after the course ended (SMD 0.29, 0.10 to 0.49), while accelerated intermittent theta burst "only maintains posttreatment effects" (SMD 0.01, -0.45 to 0.47). Their summary: "Compared with standard TMS, aTMS can rapidly improve depressive symptoms, but there is no significant difference in efficacy", and "longer follow-up periods are needed".
Worth asking
Faster is a real advantage if the alternative is six weeks of daily visits. It is not the same as better, and the trials that could show it lasts have not run long enough. What is the plan for the months after an accelerated course?
Source
Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis — Shi R, Wang Z, Yang D, Hu Y, Zhang Z, Lan D (2024)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1186/s12888-024-05545-1
DOI: 10.1186/s12888-024-05545-1
How this was scored
- Study design
- Systematic review of observational studies
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- Yes
- Conflicts disclosed
- Yes
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 15, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 62 out of 100 on our published rubric. One caveat travels with that badge: Four randomised trials is a thin base for a head-to-head conclusion, and the null difference has a wide interval (-1.62 to 0.27) that does not rule out either direction. The maintenance signal rests on short follow-up, as the authors say. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis — Shi R, Wang Z, Yang D, Hu Y, Zhang Z, Lan D (2024). Published in: Reputable peer-reviewed journal. DOI: 10.1186/s12888-024-05545-1. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of observational studies. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.