Deep TMS Reduces Suicidal Ideation by 70% in MDD, With Owen Muir, MD

Deep Transcranial Magnetic Stimulation (Deep TMS) produced a 70% relative reduction in the proportion of patients experiencing suicidal ideation, with the accelerated SWIFT protocol easing suicidal ideation at a median of 10 days compared with 13 days for standard once-daily dosing.^1,2

The analysis draws on data from BrainsWay's multisite randomized non-inferiority trial comparing the SWIFT accelerated Deep TMS protocol with standard once-daily dosing, the same trial supporting FDA clearance of SWIFT in September 2025.³ Deep TMS holds FDA clearance for major depressive disorder, including anxious depression, obsessive-compulsive disorder, and smoking addiction, but carries no FDA clearance for treating or preventing suicidal ideation or suicidal behavior.¹ The publication adds to a growing 2026 literature examining deep TMS and suicidality, including a sham-controlled trial in hospitalized patients with active suicidality and a review of 108 studies on suicidality interventions.^1,4

"Patients who aren't suicidal don't have to sit around struggling with their suicidal thoughts," said Owen Muir, MD, DFAACAP, FCTMSS, co-founder and chief medical officer at Radial. "It's better to not be suicidal."

SWIFT Accelerated Deep TMS Efficacy in Suicidal Ideation Reduction

The trial enrolled 89 patients across multiple sites in a randomized comparison of SWIFT accelerated deep TMS dosing against standard once-daily deep TMS dosing, using the Scale for Suicide Ideation (SSI) to track suicidality throughout treatment.

Investigators found the number of patients with any suicidal ideation (SSI>0) fell from 22.5% (20/89) at baseline to 6.7% (6/89) after 6 weeks of treatment, a 70% relative reduction across both dosing arms.¹ Patients assigned to SWIFT reached a median ≥ 1-point SSI improvement in 10 days, compared with 13 days for patients on the standard once-daily protocol, a statistically significant difference.¹

Muir noted many study sites delivered SWIFT over 3 half days per week across 2 weeks rather than 6 consecutive days, the compressed schedule he uses in his own clinical practice. He raises the possibility further gains in speed remain unmeasured in the trial data.

Deep TMS Safety Profile and Regulatory Status in Suicidal Ideation

Muir cautioned the trial population excluded patients with the most severe suicidality at baseline, screened per FDA trial requirements. This means that outcomes reflect a moderately suicidal cohort rather than the most acutely at-risk patients seen in clinical practice.

He characterized the divergence between faster suicidality improvement and slower overall depression scores as likely statistical noise rather than a distinct mechanism, since the trial was not powered to detect a difference in suicidality as a standalone endpoint.

"My biggest takeaway here is if you're looking at time to remission of suicidality, accelerated TMS is the clear choice," Muir said.

References

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

2. Roth Y, Tendler A, Brink E, et al. Effects of H-coil TMS on suicidality in major depression: A secondary analysis of data from a multisite randomized trial comparing accelerated to once-a-day stimulation. J Affect Disord. Published online August 21, 2026. doi:10.1016/j.jad.2026.122409

3. Accelerated TMS with the H1-coil for depression: A multisite, randomized non-inferiority trial. Brain Stimulation. 2026. doi:10.1016/j.brs.2026.103050

4. George MS, Raman R, Benedek DM, et al. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. Brain Stimul. 2014;7(3):421-431. doi:10.1016/j.brs.2014.03.006