Standard TMS is effective. For many patients, a schedule of daily sessions over several weeks is workable. But not for everyone.
Some patients need results faster — because the severity of their depression makes waiting weeks untenable. Others can’t clear their schedule for 30 consecutive weekdays. Some have tried a standard TMS course without full success and want to know what a more intensive protocol looks like.
Accelerated TMS was developed to address all three of those situations.
Accelerated TMS is not a different type of stimulation. It uses the same technology — intermittent theta-burst stimulation (iTBS) — as standard TMS. The difference is pacing.
Where standard TMS delivers one session per day, five days a week, over several weeks, accelerated TMS delivers multiple sessions per day over a dramatically compressed period. The total therapeutic stimulation is comparable; the timeline is not.
iTBS can deliver therapeutic levels of magnetic stimulation in as little as three minutes per session — making multiple-session-per-day scheduling clinically feasible without requiring each visit to last hours.
This page focuses on what the accelerated protocol adds, when it’s appropriate, and what the research shows. For a full explanation of the TMS technology underlying both approaches, see our TMS Philadelphia page
The most extensively studied accelerated TMS protocol is SAINT — Stanford Accelerated Intelligent Neuromodulation Therapy — developed by Dr. Nolan Williams and the Stanford Brain Stimulation Lab. The FDA cleared the SAINT protocol (also referred to as Stanford Neuromodulation Therapy, or SNT) in 2022.
The SAINT protocol involves five consecutive days of 10 iTBS sessions per day, with 1,800 pulses per session and 50-minute intersession intervals, delivered to the region of the left dorsolateral prefrontal cortex most functionally connected to the subgenual anterior cingulate cortex in each individual participant. SAINT is distinguished from other accelerated approaches by three specific features: individualized fMRI-guided targeting, 50-minute intersession intervals, and high pulse dose.
In the original open-label SAINT pilot study, 19 of 21 participants who completed all 50 sessions achieved remission. The subsequent double-blind RCT confirmed the approach, with remission rates that substantially exceeded those seen in standard daily TMS.
Our Accelerated TMS program is modeled after the SAINT Protocol.
A more recent development in accelerated TMS is the ONE-D protocol — Optimized Neuroplastogen-Enhanced Depression — developed at the University of Toronto by Dr. Jonathan Downar and colleagues. A retrospective case series published in the Transcranial Magnetic Stimulation Journal in 2025 (Vaughn, Marino, Downar et al.) reported outcomes for 32 treatment-resistant depression patients who underwent the protocol.
ONE-D delivers 20 iTBS sessions in a single day — approximately 9.5 hours total — with sessions spaced 30 minutes apart. ONE-D incorporates neuroplasticity enhancement: patients take a single pre-treatment dose of D-cycloserine (125 mg) and lisdexamfetamine (20 mg) approximately one hour before treatment begins, to amplify the brain’s plasticity response to the stimulation delivered throughout the day.
The results from the case series were notable. At six weeks post-treatment, patients achieved an 87.5% response rate and a 71.9% remission rate on the Hamilton Depression Rating Scale. At 26 weeks, 50% maintained sustained remission. All 32 patients completed the protocol safely, with no serious adverse events reported.
Several important caveats apply. The ONE-D case series is a retrospective, open-label study — not yet a randomized controlled trial. The contribution of the DCS and lisdexamfetamine augmentation cannot be fully separated from the overall protocol in a single-arm study. The response and remission rates, while among the highest published for any TMS protocol, should be interpreted in that context. Larger controlled trials are needed to confirm these findings.
ONE-D does not use fMRI-guided targeting — it uses standard scalp-based methods for targeting the left DLPFC, the same approach used in conventional TMS. This makes it more accessible to practices without fMRI infrastructure, while acknowledging the precision difference from SAINT.
Standard TMS: 1 session per day, 6-plus weeks total, no fMRI targeting, no neuroplasticity enhancement, RCT evidence base, FDA-cleared.
Accelerated TMS (SAINT): 10 sessions per day, 5 days total, individualized fMRI targeting, no neuroplasticity enhancement, RCT evidence base, FDA-cleared.
ONE-D: 20 sessions in a single day, 1 day total, no fMRI targeting, DCS and lisdexamfetamine neuroplasticity enhancement, retrospective case series evidence base (2025), not yet an RCT.
Accelerated TMS is available at Interventional Psychiatry of Philadelphia. The protocol involves multiple sessions per day, condensed into a shorter total treatment window than a standard course. Your treating clinician will determine whether the accelerated protocol is appropriate and what the specific parameters should look like for your situation.
Accelerated TMS and DCS-augmented TMS are not mutually exclusive. The ONE-D protocol incorporates DCS as a core component. The McLean Hospital Brain Stimulation Lab (Brown, Ganesh, Kweon, and McGirr) published a 2025 double-blind, placebo-controlled trial examining whether DCS enhances single-day accelerated iTBS — confirming the scientific rationale is being actively tested at leading research centers.
If you’re considering accelerated TMS, ask your clinician whether DCS augmentation is appropriate to add.
Accelerated TMS is particularly well suited for patients who:
Accelerated TMS uses the same stimulation technology as standard TMS — intermittent theta-burst stimulation — but delivers multiple sessions per day rather than one. A treatment course that would normally span six or more weeks can be completed in five days (SAINT protocol) or a single day (ONE-D protocol). The total stimulation is comparable; the pacing is compressed. This makes accelerated TMS practical for patients who need faster results or can’t maintain a daily schedule over several weeks.
It depends on the protocol. The SAINT protocol involves 10 sessions per day over five days — 50 sessions total. The ONE-D protocol delivers 20 sessions in a single day.
The SAINT protocol incorporates personalized fMRI-guided targeting — that precision is one of its defining features, and its RCT results reflect the complete protocol as designed. The ONE-D case series achieved comparable or higher response and remission rates without fMRI guidance, by incorporating DCS-based neuroplasticity enhancement — though as a case series, the evidence tier is lower than an RCT. What matters most is the specific protocol being used and whether it is appropriate for your clinical presentation.
Yes, in some protocols. The ONE-D protocol incorporates DCS as a core component. A 2025 double-blind, placebo-controlled trial from McLean Hospital examined this combination specifically. Whether DCS augmentation is appropriate to add to your accelerated protocol is a clinical determination.
Side effects are comparable to standard TMS: mild scalp discomfort or headache during or after sessions, which typically resolves quickly. Because sessions are more frequent in a compressed window, some patients report more fatigue during the treatment day or week. In the ONE-D case series, all 32 patients completed the protocol with no serious adverse events. Your clinician will review the full safety profile before treatment begins.
Response timing varies by protocol and individual. The ONE-D case series observed that symptom improvement built gradually over the six weeks following treatment. Some patients notice changes during the treatment period itself. There is no universal timeline, and individual variation is significant.
Yes. Accelerated TMS is available at Interventional Psychiatry of Philadelphia, 2401 Pennsylvania Ave, Suite 1C44-45, Philadelphia, PA 19130. We serve patients throughout Philadelphia, including Center City, Fairmount, Spring Garden, Northern Liberties, Fishtown, East Passyunk, West Philadelphia, and the surrounding Delaware Valley region.
Accelerated TMS condenses the timeline. It does not cut corners on clinical rigor. Every protocol is developed individually, every session is monitored, and your response is tracked throughout.
If your schedule, your situation, or your urgency makes a standard TMS course the wrong fit, accelerated TMS may be the right one.
Call 215-222-0310 or request a consultation online.
