For many people living with depression, standard antidepressant medications do not bring enough relief. In those cases, transcranial magnetic stimulation (TMS) has become an important alternative. This noninvasive therapy uses magnetic pulses to activate targeted areas of the brain linked to mood.
Traditionally, TMS requires patients to visit a clinic every weekday for six to eight weeks. That schedule can be difficult for people balancing work, family, transportation, or health challenges.
TMS is widely used for treatment-resistant depression and has been shown in large studies to significantly reduce symptoms in 60-70% percent of patients with 25-35% achieving remission. Most insurance plans cover the treatment, making it accessible for many who qualify.
Accelerated 5×5 TMS Treatment
Researchers at UCLA Health recently tested whether TMS could be delivered on a much shorter timeline. Their approach involved five sessions per day for five days, known as five-by-five, or “5×5.” The goal was to see whether compressing the schedule would still provide meaningful symptom relief.
The findings, published in the Journal of Affective Disorders, included 175 patients with treatment-resistant depression. Of those, 135 received the standard protocol of one session per day, five days a week, for six weeks. Another 40 patients underwent the accelerated format of five sessions daily for five consecutive days. Both groups experienced significant reductions in depression symptoms, and there was no statistically significant difference in overall outcomes between the two treatment schedules.
“For patients with treatment-resistant depression, getting to the clinic every weekday for at least six weeks can be a real obstacle,” said study lead author Michael Apostol, a Ph.D. student at the UCLA Semel Institute for Neuroscience and Human Behavior. “What this study suggests is that we may be able to offer those same patients a path to meaningful relief in less than one week by condensing 25 TMS treatments over just five days.”
Delayed Improvement After Treatment
One of the most noteworthy observations involved patients in the accelerated group who did not show much progress immediately after finishing their five-day course. When researchers checked back two to four weeks later, those individuals demonstrated substantial improvement, with depression scores dropping by an average of 36%.
This suggests that evaluating accelerated TMS right at the end of the five-day period may not tell the full story. Some patients who seem not to respond at first may still experience significant benefits in the following weeks.
“All patients in this study had not benefitted from multiple trials of antidepressant medication, yet they obtained great benefit from 5×5 treatment. Some patients need to wait a few days or weeks to see benefit, and we encourage them not to give up too quickly if they don’t feel better right away,” said senior author Dr. Andrew Leuchter, distinguished professor and director of the TMS Service of the UCLA Department of Psychiatry and Biobehavioral Sciences. “We are finding that the benefits of 5×5 can be even greater with an extra one-to-days of treatment after two weeks.”
What Comes Next for TMS Research
While the accelerated method produced promising results, the standard six-week course still showed stronger performance on certain longer-term measures. The researchers also emphasized that this was not a randomized clinical trial, meaning participants were not randomly assigned to each treatment group. Larger, carefully controlled studies will be needed to confirm the findings.
Beyond depression, UCLA scientists are studying TMS for other conditions, including obsessive-compulsive disorder and chronic pain. As research expands, TMS may play a growing role in the next generation of brain-based treatments for mental health.