Accelerated Deep TMS for Acute Suicidality, With Owen Muir, MD

Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial, said accelerated SWIFT Deep TMS has become his personal first-line treatment approach for patients with major depressive disorder (MDD) and active suicidal ideation. This clinical practice pattern predates current professional guideline recommendations. As of now, the Cleveland Clinic, last medically reviewed in 2024, recommends a safety plan, cognitive behavior therapy, medications, or inpatient or outpatient mental health programs for patients with suicidal ideation.¹

Muir authored the first large-scale open-label comparison of once-daily versus accelerated Deep TMS dosing in 2020, work preceding the FDA clearance of the SWIFT protocol in September 2025.^2,3 No current American Psychiatric Association (APA) or American College of Physicians (ACP) guideline designates TMS as first-line specifically for acute suicidality.

Intranasal esketamine, not TMS, currently holds FDA approval for MDD with active suicidal ideation.⁴ Muir said he considers accelerated Deep TMS numbers favorable relative to esketamine outcomes, though he noted the treatments have not been directly compared in a head-to-head trial.

"This is a go-to treatment," Muir said. "This is a first-line treatment [for] patients with acute suicidality.”

SWIFT Deep TMS Access and Real-World Feasibility

Radial has built its clinical program, now spanning 27 sites, around delivering accelerated Deep TMS protocols.⁵ Muir said patients overwhelmingly prefer the compressed schedule to standard once-daily dosing, since no one wants to remain suicidal any longer than necessary, and he described high satisfaction among both patients and clinicians with the approach. He identified scheduling infrastructure, not efficacy, as the main barrier keeping other practices from adopting accelerated protocols at scale.

Advancing SWIFT Deep TMS Evidence and Payer Coverage

Muir said the next step toward influencing practice guidelines is replicating the suicidality findings in larger real-world datasets using a mirror-image design, comparing retrospective outcomes before and after SWIFT adoption. He said this depends on payers reliably covering accelerated TMS with appropriate billing codes and treating suicidality evaluations as same-day coverage decisions rather than prior authorizations spanning days to weeks.

Muir disclosed he was himself treated with Deep TMS during a suicidal episode tied to bipolar depression, selecting a BrainsWay coil based on available data before later becoming a TMS researcher.

“Everyone deserves the opportunity to let the suicidality go, and I will stop at nothing to make this a standard of care,” Muir said.

Watch part 1 of our interview with Muir on new Deep TMS data here: Deep TMS Reduces Suicidal Ideation by 70% in MDD, With Owen Muir, MD

Editor’s note: Reported disclosure for Muir includes Medtronic.

References

1. Suicidal Ideation (Suicidal Thoughts). Cleveland Clinic. Published July 23, 2024. Accessed September 3, 2026. https://my.clevelandclinic.org/health/symptoms/suicidal-ideation

2. Tendler A, Goerigk S, Zibman S, et al. Deep TMS H1 Coil treatment for depression: Results from a large post marketing data analysis. Psychiatry Res. 2023;324:115179. doi:10.1016/j.psychres.2023.115179

3. Walters J. FDA Clears Accelerated Protocol for Deep TMS to Treat Major Depressive Disorder. PsychiatricTimes. Published September 17, 2025. Accessed September 3, 2026. https://www.psychiatrictimes.com/view/fda-clears-accelerated-protocol-for-deep-tms-to-treat-major-depressive-disorder

4. Kunzmann K. FDA Approves Esketamine for Depressive, Suicidal Symptoms. HCPLive. Published August 4, 2020. Accessed September 3, 2026. https://www.hcplive.com/view/fda-approves-esketamine-depressive-suicidal-symptoms

5. BrainsWay Deep TMS™ study shows 70% reduction in patients experiencing suicidal ideation. BrainsWay. Published August 27, 2026. Accessed September 2, 2026. globenewswire.com/news-release/2026/08/27/3351903