In the previous post, we looked at three main families of TMS protocols: classical once‑daily TMS, once‑daily theta‑burst, and accelerated options such as SAINT‑style and BrainsWay SWIFT™. In this blog, we focus on what patients care about most: How well do these approaches work? How fast? And what do we know so far about suicidal thoughts and crisis symptoms?
Because research is ongoing, the numbers below are approximate and may evolve over time, but they give a useful, honest frame for discussion.
Success rates with “regular” TMS
When people talk about “standard” or “regular” TMS, they generally mean a once‑daily protocol over several weeks, using either high‑frequency or once‑daily theta‑burst patterns.
Across many studies and real‑world clinics, for treatment‑resistant depression:
- About 50–60% of patients have a meaningful response (their depression improves substantially).
- About 30–40% reach remission, meaning their symptoms fall into the minimal or no‑depression range by the end of a full course.
- In a large real‑world study of Deep TMS with the H1 coil led to an 81.6% response rate and a3% remission rate among patients who completed at least one validated depression scale
These numbers can vary depending on:
- How severe and chronic the depression is
- How many medications have already failed
- The specific device and parameters used
The key point: even in patients who have not improved with multiple medications, regular TMS helps a significant proportion of people get better, and a smaller but important group become essentially well.
Success rates with accelerated TMS
Accelerated protocols are newer, but early data are encouraging. They generally look at:
- Response: large, clinically meaningful improvement
- Remission: symptoms reduced to the mild or non‑depressed range
- Speed: how quickly that improvement happens
Across different accelerated protocols (including SAINT‑style and accelerated Deep TMS like SWIFT), published trials and growing real‑world data suggest:
- Response rates often in the 60–80% range
- Remission rates commonly in the 40–60% range
In many studies, accelerated protocols are at least as effective as regular TMS, and sometimes show higher response/remission rates in similar treatment‑resistant populations. The big advantage is usually speed: instead of waiting several weeks, many patients see substantial improvement during or shortly after the intensive, multi‑session‑per‑day phase.
However, it’s important to keep in mind:
- These protocols are newer, and long‑term durability data are still developing.
- Not all accelerated designs are equal; some are more intensive than others.
- Availability, insurance coverage, and eligibility criteria can differ from standard TMS.
What about suicidal thoughts and crisis symptoms?
Suicidal thoughts and crisis‑level depression are among the most urgent concerns in clinical practice. Early work with intensive TMS schedules, especially highly accelerated protocols, suggests:
- Faster reductions in suicidal ideation than we typically see with standard once‑daily TMS.
- In some studies, a substantial proportion of patients with high baseline suicidal thoughts have marked improvement within days.
That said:
- TMS—regular or accelerated—is not a stand‑alone emergency service. Patients in acute suicidal crisis still need crisis‑level care (ER, hospitalization, crisis lines), safety planning, and close monitoring.
- TMS can be part of a comprehensive treatment plan aimed at reducing suicidal thinking over days to weeks, but it does not replace immediate safety measures.
In our practice, we treat suicidality as a separate, prioritized target: we assess risk at every visit, coordinate with other providers, and combine TMS with careful medication management , ketamine treatments whenever possible.
The most important thing is that you don’t have to navigate these choices alone. A careful, individualized evaluation can help you understand which protocol—or combination of approaches—makes the most sense for your situation right now. Lets explore this in part three of this blog sequence .