Transcranial magnetic stimulation (TMS) has been FDA-cleared for major depressive disorder (MDD) since 2008, but for many patients with treatment-resistant depression (TRD), the traditional TMS treatment schedule has been the biggest obstacle to accessing it.1 The standard protocol requires 36 sessions, once daily, over 6 to 8 weeks, a commitment that costs patients their mornings, their commutes, and sometimes their jobs. For those living far from a TMS clinic, it has often meant no treatment at all.
That is beginning to change.
In this video, 3 clinician-researchers, Linda Carpenter, MD, of Brown University; Andrew Leuchter, MD, of UCLA TMS Clinical and Research Services; and Scott Wilke, MD, PhD, Penske Family Chair in Neuromodulation at UCLA Health, walk through what is new in TMS for MDD and what it means for practicing psychiatrists treating patients who have not responded to antidepressants.
What New TMS Protocols for Treatment-Resistant Depression Mean for Clinical Practice
The clinical case for accelerated TMS protocols is building. A retrospective analysis published in March 2026 found that a 5x5 accelerated rTMS regimen, 5 sessions per day over 5 consecutive days, produced efficacy comparable to the conventional 6-week TMS course.2 A second study examining BrainWay’s SWIFT deep TMS protocol reached a similar conclusion.3 As Leuchter explained in an interview with HCPLive, the compressed timeline has real implications for patient access and adherence, though insurance reimbursement for accelerated TMS approaches remains a significant gap.
TMS for MDD: Key Data Points
FDA-cleared since 2008—yet access barriers have limited TMS use in TRD for nearly 2 decades.
No significant efficacy difference—a March 2026 retrospective analysis found comparable outcomes between 5x5 accelerated rTMS and the conventional 6-week daily course (P =.07).
21.3% vs 6.0%—remission rates for ProlivRx vs sham in the MOOD trial (P =.027).
Coverage gap — Medicare reimburses up to 2 TMS sessions per day; accelerated protocols of 5 or more sessions per day remain unreimbursed as of 2026.
On the at-home neuromodulation front, the FDA approved Neurolief’s ProlivRx in January 2026, the first prescription, physician-directed at-home brain stimulation therapy for MDD, indicated for adults who did not achieve satisfactory improvement from ≥ 1 prior antidepressant.4 Carpenter, who led the MOOD trial studying the device as adjunctive therapy, describes how the physician-directed model works in practice and what the current reimbursement landscape looks like for patients.
Wilke adds mechanistic context on how accelerated intermittent theta burst stimulation acts on specific cell types in the prefrontal cortex and what that could mean for personalizing TMS treatment for MDD.
For a deeper dive into the data behind each of these developments, read the full written feature here: TMS for MDD Reimagined: Faster, Fewer Visits, and Now at Home.5
Editor’s note: Reported disclosures include Neuronetics and Janssen Pharmaceuticals for Carpenter and Abbott Laboratories for Leuchter. Wilke has no reported disclosures.
References
Derman C. TMS for MDD Reimagined: Faster, Fewer Visits, and Now at Home. HCPLive. Published on May 15, 2026. Accessed June 18, 2026. https://www.hcplive.com/view/tms-mdd-faster-fewer-visits-home
