One-Day Accelerated TMS: What the Early Evidence Shows

One-day TMS compresses an entire course of transcranial magnetic stimulation into a single long clinic day, in the best-known version 20 short theta-burst sessions spaced 30 minutes apart, combined with medications given to enhance brain plasticity. No single-day schedule is FDA-cleared, and the medications used in the best-known version are prescribed off-label. The published evidence consists of small, unblinded case series and one small placebo-controlled study that did not find a benefit from the added drug.

That does not make the idea worthless. It makes it early. Anyone considering a one-day course should understand exactly what has and has not been shown, and how it differs from the multi-day accelerated TMS protocols that do hold FDA clearances.

What "one-day TMS" usually means

Standard TMS for depression is given once a day, five days a week, for about six weeks. Accelerated TMS packs several sessions into each day so the course finishes sooner. Single-day protocols push that logic to its limit: the whole dose is delivered between morning and evening.

Three distinct single-day approaches have been described in the literature so far. They differ in pulse pattern, total dose and whether a drug is added, so results from one cannot be borrowed for another.

The term "one-day TMS" in advertising most often refers to ONE-D or a variant of it, so that is where most of the scrutiny belongs.

The ONE-D case series, read closely

The headline numbers are striking. At week 6, 28 of 31 assessed patients (90.3%) met HDRS-17 response criteria (at least a 50% improvement) and 23 of 31 (74.2%) met remission criteria (a score under 8). At week 12, among the 27 patients with data, HDRS-17 response was 92.6% and remission 77.8%.

Several features of the study limit what those figures can mean:

• There was no control group of any kind, for the TMS or for the drugs.
• All HDRS-17 ratings were done by one rater, an author employed by the companies involved, and no one was blinded.
• Thirteen of the 32 patients (40.6%) had already had TMS and were described as previous TMS responders, a group in which the authors themselves said a higher remission rate would be expected.
• Seven patients could not tolerate the target intensity of 120% of motor threshold.
• Several authors are co-founders or employees of Ampa Health, the company whose device was used.
• The version read for this article is a preprint labelled as not peer reviewed.

Sham-treated patients in TMS trials improve substantially on their own; a large meta-analysis of sham arms found a within-group effect size of about 0.8. Without a comparison arm, there is no way to separate the protocol's effect from expectation, regression toward the mean and the careful attention patients receive. For a fuller explanation of why uncontrolled percentages run so high, see how TMS success is measured.

The one placebo-controlled test

The key ingredient that distinguishes ONE-D from plain accelerated iTBS is the pharmacological "boost". D-cycloserine is a partial NMDA-receptor agonist that has been reported to enhance TMS-induced plasticity in the motor cortex, the same kind of learning-like change that repeated TMS aims to produce. That is a reasonable hypothesis, and it has been tested once in a single-day design.

In the Ganesh study, 30 patients received 10 hourly iTBS sessions with either d-cycloserine 250 mg or placebo the night before. There was no between-group difference on the PHQ-9 or QIDS-SR16, and PHQ-9 scores did not improve significantly over time, although QIDS-SR16 scores did (p=.047). This is also a preprint, and the dose and timing differed from ONE-D, so it does not disprove ONE-D. It does show that the drug-enhancement idea has not yet held up when someone checked it against placebo. The broader research on drug-plus-TMS combinations is covered in combining TMS with medication.

FDA status: cleared device, uncleared schedule

A TMS device can be FDA-cleared while a particular way of using it is not. The Clinical TMS Society's statement on single-day TMS makes exactly this point: the ONE-D protocol "was not FDA cleared", even though the device used is cleared for standard treatment.

Accelerated protocols that have been cleared look quite different from a single day:

• SAINT (Magnus Neuromodulation System, cleared 2022) delivers 10 sessions a day for 5 days, with an MRI-derived individual target. Details are in the SAINT/SNT guide.
• BrainsWay's accelerated deep TMS protocol (cleared 2025) runs 30 sessions over 6 treatment days within 2 weeks, followed by weekly sessions, for a 6-week total.
• MagVenture's accelerated clearance (2026) covers schedules from 2 up to 10 sessions per day, with or without MRI-based targeting.

The society's statement concluded that the evidence as of December 2025, one case series of 32 patients, which the society counted as peer-reviewed, and one abstract of 8, did "not meet the threshold to recommend" ONE-D over better-studied approaches, and that clinics should be transparent about its off-label status and low level of evidence.

Why compressing the dose is plausible, and why it is not proven

There is real science behind accelerated TMS. A 2026 meta-analysis of 15 sham-controlled accelerated iTBS trials found a moderate effect over sham, though fewer than half of the trials were at low risk of bias. A separate 2026 dose-response analysis of accelerated rTMS found that intersession intervals of roughly 30 to 75 minutes did better than shorter or longer spacing. ONE-D's 30-minute spacing sits at the short end of that window.

What those analyses cannot tell anyone is whether one day is enough. The accelerated protocols that hold FDA clearances spread treatment over several days or weeks. The mechanism of action, explained in how TMS works, involves plasticity built up over repeated sessions. Whether that process needs days between treatments, or only enough pulses, has not been tested head to head.

What is still unknown

• Durability. No controlled study has reported long-term outcomes. ONE-D followed patients to week 12 without a control group, and the Goodman pilot reported 90-day naturalistic clinic data, with 41 of 53 maintaining response. How long benefits last after any course is covered in how long TMS results last.
• Safety at scale. Seizures from TMS are rare and tend to occur within the first few exposures. Case series of a few dozen people are far too small to estimate a rare risk, and a single-day course concentrates many exposures, plus a stimulant, into one day. See TMS safety and seizure risk.
• Who it suits. Previous TMS responders made up a large share of the ONE-D sample, so results in people new to TMS are especially uncertain.
• Coverage. Because the schedule is not cleared and the evidence is thin, insurers are unlikely to treat it like standard TMS; see whether accelerated TMS is covered and payer pages such as Aetna's TMS criteria.

Questions to ask before a one-day course

1. Is this exact schedule FDA-cleared, or is it an off-label use of a cleared device?
2. Which medications will be given, at what dose, and are they off-label for this purpose? How do they interact with what I already take?
3. What published data, with sample sizes and control groups, support this specific protocol?
4. How is my motor threshold measured, and what happens if I cannot tolerate the target intensity? (See motor threshold and dosing.)
5. Who is physically on site during the day, and what is the plan if a seizure or fainting episode occurs?
6. What follow-up is planned, and what happens if symptoms return in a month?
7. What will this cost, and what would a standard or cleared accelerated course cost instead?

When a one-day course is the wrong first step

Single-day TMS is not an emergency treatment. Expert consensus recommends that people with psychotic symptoms or acute suicidal ideation be considered for treatments with established efficacy, such as ECT. Someone who has never tried a standard, cleared course has well-studied options that should usually come first, and a broader comparison is in treatment-resistant depression options. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

For an overview of TMS options and how they compare, the TMS guide is the place to start; to discuss whether any form of TMS fits your situation, see TMS therapy with a psychiatrist in Brooklyn.

Frequently asked questions

Is one-day TMS the same as SAINT?

No. SAINT is a 5-day course of 10 sessions a day with an MRI-derived target, and it is FDA-cleared. Single-day protocols such as ONE-D deliver everything in one day, often with off-label medications, and are not FDA-cleared.

Why are medications given before single-day TMS?

The idea is that drugs such as d-cycloserine may enhance plasticity so a short course has a larger effect. The only placebo-controlled single-day test of d-cycloserine found no difference from placebo.

Can I go back to work the day after a one-day course?

TMS does not involve anesthesia, but a single-day course takes most of a day and may include a stimulant and another drug. Ask the treating team about the specific medications, driving and when follow-up visits are scheduled.

What should I make of a 90% success rate for one-day TMS?

That figure comes from an unblinded case series of 32 people, about 40% of whom had already responded to TMS before. It is a reason for further study, not a figure to expect for yourself. See the landmark TMS trials for comparison.

Is single-day TMS safe?

Standard TMS has a very low seizure rate. Single-day protocols have been studied in too few people to estimate rare risks, so the honest answer is that the safety profile is not yet well characterized.

Sources

1. Real-world effectiveness of a single-day regimen for transcranial magnetic stimulation using Optimized, Neuroplastogen-Enhanced techniques in Depression (ONE-D). Research Square (preprint), 2024. doi.org
2. Clinical TMS Society's Statement on Level of Evidence for Single-Day TMS combined with Medications. Clinical TMS Society, 2025. clinicaltmssociety.org
3. Single-day accelerated TMS with D-cycloserine augmentation for depression: A placebo-controlled trial. Research Square (preprint), 2025. pubmed.ncbi.nlm.nih.gov
4. Rectangular Pulse Three-Hour Repetitive Transcranial Magnetic Stimulation Treatment for Major Depressive Disorder: A Pilot Trial. Neuromodulation, 2026. pubmed.ncbi.nlm.nih.gov
5. 510(k) Summary K220177 – Magnus Neuromodulation System with SAINT Technology. U.S. FDA, 2022. accessdata.fda.gov
6. 510(k) Summary K251449 – BrainsWay accelerated Deep TMS. U.S. FDA, 2025. accessdata.fda.gov
7. 510(k) Summary K260189 – MagVenture Accelerated TMS (aTMS) Therapy System. U.S. FDA, 2026. accessdata.fda.gov
8. MagVenture Receives FDA Clearance for Accelerated TMS Protocols, Expanding Flexibility for Clinics and Patients. MagVenture, 2026. magventure.com
9. Accelerated intermittent theta-burst stimulation for major depressive episodes: systematic review and dose-response meta-analysis. Brain Stimulation, 2026. pubmed.ncbi.nlm.nih.gov
10. Dose-response associations of total pulse dose and intersession interval with clinical outcomes in accelerated rTMS for major depressive episodes: A systematic review and meta-analysis. Brain Stimulation, 2026. pubmed.ncbi.nlm.nih.gov
11. A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2018. pubmed.ncbi.nlm.nih.gov
12. Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clinical Neurophysiology, 2019. europepmc.org
13. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry, 2018. pmc.ncbi.nlm.nih.gov

Educational information, not medical advice. Whether TMS or any treatment fits you is a decision to make with a psychiatrist who knows your history.