For many people living with depression in LA, the hardest part of starting transcranial magnetic stimulation is not the treatment itself but the calendar. A standard course asks for daily visits over several weeks, which can be difficult to sustain alongside long commutes, demanding jobs, caregiving, or travel. Accelerated TMS was developed to address that burden by delivering many treatments in a much shorter span of days. At NeoPsych in Glendale, Dr. Thomas Hughes and our clinicians offer both standard and accelerated TMS, and we were the first practice in Glendale to offer accelerated protocols. Knowing how the two approaches truly differ, and where they overlap, can help you choose a path that fits both your clinical needs and your life.
What Standard and Accelerated TMS Have in Common
Both standard and accelerated TMS rely on the same core principle. A magnetic coil placed against the scalp delivers focused pulses to the left dorsolateral prefrontal cortex, a region near the front of the brain that communicates with deeper networks involved in mood. Over repeated sessions, this stimulation is thought to encourage neuroplastic changes, meaning the brain gradually strengthens healthier patterns of activity. Neither approach requires anesthesia, patients remain awake throughout, and neither involves the systemic side effects associated with many antidepressant medications.
The two approaches also share the same careful screening process and the same common side effects, including scalp discomfort, headache, and fatigue. In both cases, treatment at NeoPsych begins with a thorough evaluation by Dr. Hughes, who reviews your history, current symptoms, past medications, and goals. The meaningful differences lie in how the treatment is scheduled, how each session is delivered, how the target is located, and how treatment is paid for. Our TMS therapy overview explains the standard process step by step for those who are new to TMS.
Key Differences Between Accelerated and Standard TMS
Schedule and Time Commitment
Standard TMS is typically delivered once a day, Monday through Friday, for roughly 36 treatments over about six to seven weeks. Each visit is short enough that most people continue working, and many patients in Glendale, Burbank, and Pasadena fit sessions into a lunch break or a morning routine. Accelerated TMS compresses treatment into a much shorter window by delivering multiple sessions per day, with rest intervals in between. At NeoPsych, accelerated options range from a single day to ten treatment days, which may require taking time away from work but can spare patients many weeks of daily travel across LA. Accelerated treatments also allow patients who live further away from the Glendale office to access the treatment due to the shorter time commitment.
Targeting and Precision
With standard TMS, the treatment site is commonly located using scalp measurements or a fitted cap, a method that has been trusted since TMS became available to the public. At NeoPsych, we also offer 3D-guided positioning, which creates an individualized head model so the coil can be placed consistently from session to session. For patients who want the most individualized option, our 5-Day fcMRI-guided protocol uses functional connectivity MRI to identify a personalized target, with each reading reviewed by a trained neuroscientist. The MRI is an optional add-on rather than a requirement, so patients with claustrophobia or other concerns can still pursue accelerated treatment.
Insurance and Regulatory Status
Standard TMS for major depressive disorder is covered by many major insurance plans, usually after a patient has tried more than one class of antidepressant and a course of psychotherapy. At NeoPsych, we handle the prior authorization process and schedule patients within days of approval. Accelerated TMS is generally not covered by insurance, which also means patients do not necessarily need to complete multiple medication trials first. It is also important to know that the specific accelerated protocols we offer, including the ONE-D, 5-day, and 10-day schedules, are not FDA approved and are performed off-label, a point we discuss openly during consultation. You can review accepted plans on our insurance page.
Common Questions About Accelerated TMS
Patients often ask whether accelerated TMS works faster or better than standard treatment. The research is encouraging but still developing. A systematic review and meta-analysis by Sonmez and colleagues in Psychiatry Research in 2019 concluded that accelerated TMS improves depressive symptom severity, while noting that study methods and blinding could be strengthened. In a sham-controlled trial of a high-dose, accelerated iTBS protocol.
Not every study shows faster results, and we believe that nuance matters. In a three-arm randomized trial of 300 patients published in Brain Stimulation in 2021, Chen and colleagues found that accelerated bilateral theta burst stimulation delivered over ten days produced response and remission rates similar to four weeks of daily 10 Hz rTMS, but it was not associated with more rapid improvement. In other words, accelerated TMS may offer a shorter time commitment and comparable outcomes for some patients, rather than guaranteed faster relief. Individual results vary with diagnosis, treatment history, protocol, and other factors.
Another common concern is whether accelerated TMS is riskier. Because more pulses are delivered over fewer days, some patients notice more scalp tenderness or fatigue during the treatment window, although these effects are typically transient. The serious risks, including the rare possibility of a seizure, are managed through the same careful screening and monitoring used for standard TMS. Many patients also ask about maintenance, and in our experience some people benefit from follow-up or booster sessions to help sustain their gains.
Our Accelerated TMS Protocols and How We Customize Care
At NeoPsych, our Signature approach to accelerated TMS begins with matching the protocol to the person. Dr. Hughes is involved with every TMS appointment in Glendale, CA,, which allows our clinicians to monitor comfort, track symptoms, and adjust care in real time. We currently offer three accelerated schedules alongside standard TMS, and the right choice depends on symptom severity, prior treatment history, medical eligibility, and how much time a patient can set aside.
ONE-D Protocol
The ONE-D Protocol delivers 20 iTBS sessions in a single, highly structured day, combined with carefully timed medications intended to enhance neuroplasticity, D-cycloserine and lisdexamfetamine (Vyvanse). The rationale is supported by early research: in a randomized clinical trial of 50 adults with major depressive disorder, Cole and colleagues reported in JAMA Psychiatry in 2022 that adding low-dose D-cycloserine to iTBS over a four-week course produced greater improvement than iTBS with placebo. That study used daily iTBS rather than a one-day schedule, so it supports the concept rather than the ONE-D format specifically. Improvement after ONE-D tends to emerge gradually over the following weeks rather than immediately.
5-Day fcMRI-Guided Protocol
The 5-day protocol delivers ten iTBS sessions per day for five consecutive days, totaling 50 treatments, with roughly 50-minute intervals between sessions. It is designed for adults with major depressive disorder who have not responded adequately to multiple antidepressant trials or psychotherapy, and it can be paired with optional fcMRI-guided targeting.
10-Day Protocol
The 10-Day Accelerated TMS Protocol delivers the same 50 iTBS sessions at a gentler pace, with five sessions per weekday over two weeks. This option allows more rest between sessions and days, which may help patients who are more sensitive to side effects or who need to balance work, school, or family obligations. As with our other accelerated options, an MRI is not required for the 10-day schedule, although fcMRI-guided targeting is available as an add-on.
Candidacy and Contraindications
Accelerated TMS has been studied primarily for major depressive disorder, while standard TMS has a broader evidence base across conditions such as OCD and anxiety. Both approaches require medical screening, and TMS is generally not appropriate for people with metal implants in or near the head, certain implanted devices, or unmanaged seizure risk. We also review current medications, substance use, and any history of bipolar disorder before recommending a protocol.
What to Expect With Accelerated TMS
An accelerated treatment day typically begins in the morning and continues into the late afternoon. After the first session establishes the treatment location, each subsequent session follows the same pattern: check in, discuss any side effects, receive a brief stimulation session, and rest until the next one. Patients often read, watch shows, or simply relax between treatments. Because the schedule is intensive, we recommend arranging lighter responsibilities during treatment days and planning for rest in the evenings.
Some patients notice early shifts in mood, sleep, or anxiety within days, while others improve gradually over the weeks that follow. Side effects such as headache, scalp tenderness, and tiredness are usually short-lived. After treatment, we continue to monitor progress and discuss whether follow-up sessions, medication management, or therapy referrals within our trusted network may help you maintain your progress.
If you are experiencing thoughts of suicide or self-harm at any point, please seek help immediately. You can call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day, or call 911 in an emergency. TMS is an outpatient treatment and is not a substitute for urgent crisis care.
Choosing Between Standard and Accelerated TMS
Neither approach is universally better, and the best choice is the one that aligns with your clinical picture, schedule, and personal circumstances. Standard TMS may suit patients who want to use insurance coverage, prefer to keep working without interruption, or are seeking treatment for conditions beyond depression. Accelerated TMS may suit patients with limited time, those traveling to NeoPsych from elsewhere in LA or beyond, or those who prefer to complete treatment in a concentrated window. Dr. Hughes will walk you through the evidence and the practical tradeoffs so you can make a well-informed decision.
Schedule a Consultation With Dr. Hughes
If you are weighing accelerated TMS against standard TMS, a consultation at NeoPsych can bring clarity. Dr. Thomas Hughes will review your history, explain which protocols you may qualify for, and answer questions about scheduling and side effects. Our office is located at 1510 S Central Avenue, Suite 615, in Glendale, with convenient access from Burbank, Pasadena, and Downtown Los Angeles, and virtual consultations are also available. When you are ready, you can contact NeoPsych or call (213) 433-2823 to schedule a visit with our team.