Evidence map›Paper›PMID 41651240›Full record

ArticleJournal of affective disorders2026

Efficacy of 5 × 5 accelerated versus conventional repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression.

Michael R Apostol, Thomas E Valles, Juliana Corlier, Michael K Leuchter, Alexander S Young, Hewa Artin, Ralph J Koek, Evan H Einstein, Scott A Wilke, Hanadi A Oughli and 7 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Michael R ApostolDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA. Electronic address: michaelrapostol@ucla.edu.
Thomas E VallesDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Juliana CorlierDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Michael K LeuchterDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Alexander S YoungDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Hewa ArtinDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Ralph J KoekDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Evan H EinsteinDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Scott A WilkeDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Hanadi A OughliDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Thomas StrouseDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Aaron SlanDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Margaret G DistlerDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Dustin Z DeYoungDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA.
Nathaniel GinderDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
David E KrantzDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.
Andrew F LeuchterDepartment of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA; TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza Suite 57-430, Los Angeles, CA, 90024, USA.

Funding

Resonant Frequency rTMS: A Novel Approach to Target Circuit Modulation in MDDR01MH135293 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI LINDA L CARPENTER, ANDREW F LEUCHTER · 2024 to 2026
$2.1M
Multi-target repetitive Transcranial Magnetic Stimulation (rTMS) treatment for Major Depressive Disorder (MDD) and comorbid painK01MH123887 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Juliana Corlier · 2022 to 2026
$732k
NIMH NIH HHS K01 MH123887NIMH NIH HHS R01 MH135293
6 · The paper itself

Abstract

backgroundAccelerated repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD), with an FDA-cleared protocol utilizing 10 sessions of prolonged intermittent Theta Burst Stimulation (piTBS) per day for five days. However, it remains unclear how many sessions and pulses are necessary to achieve benefit.

methodsIn a retrospective analysis of clinical data, we examined efficacy of five rTMS stimulation sessions per day for five days ("5 × 5") (N = 40) of either piTBS or individualized, electroencephalogram-based "resonant frequency" (RF) stimulation, and used mixed-effects linear models to compare these accelerated protocols to a standard once-daily rTMS protocol where patients received one rTMS session per day, 5 days a week, for 6 weeks (N = 135).

resultsBoth protocols ameliorated MDD symptoms and there were no statistically significant differences in depression symptom changes (p = 0.07) between the accelerated 5 × 5 protocol (mean PHQ-9: pre-rTMS = 17.68, post-rTMS = 10.98) and conventional once-daily treatment (mean PHQ-9: pre-rTMS = 17.83, post-rTMS = 8.97) at treatment completion (treatment day 5 for the 5 × 5 patients and treatment day 30 for the conventional patients). There was no significant difference in improvement between the piTBS and RF 5 × 5 protocols (p = 0.9). A PHQ-9 median split of 5 × 5 patients revealed that the top half of patients showed robust depression improvement (69%) while the bottom half received no significant benefit (8%) by day 5. However, the bottom half showed significant improvement (36%) at two-to-four-week follow up (p = 0.001).

conclusionsThese results suggest 5 × 5 accelerated rTMS treatment may be as effective as once daily rTMS treatment for many patients, and should be explored in future randomized clinical trials. It is critical to perform prolonged follow-up assessments in such trials because the efficacy of accelerated treatment may not be accurately assessed until weeks after treatment completion.

Indexed as

Depressive Disorder, Treatment-ResistantMajor Depressive DisorderTranscranial Magnetic StimulationAdultElectroencephalographyFemaleHumansMaleMiddle AgedPatient Health QuestionnaireRetrospective StudiesTreatment OutcomeAccelerated TMSDepressionMDDNeuromodulationProlonged intermittent theta burst stimulation (piTBS)Repetitive transcranial magnetic stimulation (rTMS)Treatment

Identifiers

PMID41651240
PMCPMC13549463

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.