ACCELERATED TMS THERAPY

    Accelerated TMS

    50 Sessions In Just 5 Days


    Florida Accelerated TMS is basically aiTBS, which stands for accelerated intermittent Theta Burst Stimulation. This aiTBS depression treatment protocol uses a unique form of Transcranial Magnetic Stimulation called intermittent Theta Burst Stimulation, delivering 1800 pulses in less than 10 minutes every hour, 10 times a day for 5 days. In total, delivering 50 treatment sessions equivalent to 90,000 pulses in 5 days. Our aiTBS program at Florida TMS Clinic doesn’t use brain imaging to determine the magnetic stimulation's target area. Instead, we use a non-MRI-based navigation system that calculates the target area based on the patient skull measures. The lack of fcMRI targeting is the main difference between FLORIDA TMS CLINIC’s aiTBS and SAINT TMS. While SAINT TMS protocol is FDA-cleared, it is still not commercially available for TMS clinics to acquire. Florida TMS Clinic Accelerated TMS is not FDA-cleared, but it is available today. Florida Accelerated TMS is an alternative for those looking for fast relief from depression while we await the production of the SAINT TMS device.


    Accelerated TMS vs. SAINT TMS


    KEY TAKEAWAYS:


    • Florida Accelerated TMS is 1800 pulses of iTBS done every hour, 10 times a day, for 5 days.
    • Florida Accelerated TMS doesn’t use MRI for its navigational targeting.
    • Florida Accelerated TMS is not FDA-cleared. 
    • Florida Accelerated TMS is available now for select patients until SAINT becomes available.



    To be clear, Florida Accelerated TMS without fcMRI is not SAINT, but it is close enough for now until Magnus Medical makes a TMS device capable of doing SAINT protocol with the fcMRI (late 2023). If you want to read more about SAINT, please click this         link to my detailed article that spells out what we know about SAINT so far.


    If you are interested in accelerated TMS, please         call us to see if you meet our criteria for Florida Accelerated TMS. Please note that most insurance plans do not cover accelerated TMS.


    What Is Accelerated TMS?

    The term accelerated TMS is used in the medical literature to describe any TMS therapy protocol applying more than one TMS session a day. Today, the terminology accelerated TMS and accelerated TBS is commonly used to describe the TMS therapy protocol in which the patient gets 10 TMS therapy sessions a day for 5 days for a total of 50 TMS therapy sessions. This accelerated TMS therapy protocol shortens the duration of treatment from 6 weeks to just 5 days. Accelerated TMS therapy is particularly interesting because it could drastically improve how we do TMS therapy for depression.


    Traditional treatments for depression, like antidepressant medications and talk therapy, are facing many challenges. It’s not uncommon for such treatments to be ineffective. It takes what feels like, forever to get some response. And, of course, medications are associated with frequent side effects. Thanks to repetitive Transcranial Magnetic Stimulation (rTMS) and intermittent Theta Burst Stimulation (iTBS), we now have an effective alternative treatment for treatment-resistant depression (TRD). 


    TMS therapy has been used in clinical psychiatric practice since 2008 in the USA following its clearance by the FDA. It is non-invasive and drug-free, with none of the systemic side effects associated with medications. Despite the breakthrough it provided, rTMS is challenged by the inconvenience of the duration of the treatments. A TMS therapy session takes between 19 to 37 minutes. When you consider that a full treatment course is about 30 sessions, that’s a lot of time on the treatment chair.


    Fast forward 10 years to 2018, a new breakthrough in TMS revolutionized our treatment options. Intermittent Theta-Burst Stimulation (iTBS) is the “version 2.0” of rTMS. Just like rTMS, iTBS is a non-invasive brain stimulation treatment that is FDA-cleared for treatment-resistant depression (TRD). It uses a different magnetic pulse at a higher frequency, delivering the treatment in just about 3 minutes. iTBS was proven in 2018 to be as effective as rTMS with the obvious time-saving of over 5 folds. This also opened the door to newer methodologies for providing TMS therapy. More importantly, giving multiple sessions a day. This is called accelerated TMS. Accelerated TMS evolved over time to allow the course of the treatment to be shortened from 6 weeks to just 5 days!


    Is Accelerated TMS Therapy Effective?

    Clinical research supports the efficacy of accelerated TMS therapy for depression treatment. Let’s look at the evidence available today!


    A significant amount of research done exploring accelerated TMS started in Europe, particularly in Belgium. Based on a 2014 study, it was concluded that Accelerated TBS treatment in depressed, suicidal patients is safe and well-tolerated and may have the potential to acutely decrease suicidal ideations.


    A couple of years later a study was published in the Journal of Affective Disorders in 2016 found that 20 sessions of iTBS Given 5 sessions a day for only four days of accelerated iTBS treatment applied to the left DLPFC in TRD may lead to meaningful clinical responses within two weeks after stimulation.


    Then in a clinical trial published in 2018, the group compared accelerated high-frequency rTMS (arTMS) with accelerated intermittent theta burst stimulation (aiTBS) in the refractory depressed state. The clinical efficacy was not significantly different between both protocols. This substantiates the potential of the accelerated stimulation to shorten the treatment duration from the depressed state to the response state. Any time gain from the depressed state to the recovered state is in the patients’ interest.


    What Is SAINT Protocol?

    The recent breakthrough in accelerated TMS came from Stanford University and was published in the prestigious peer-reviewed American Journal of Psychiatry in April 2020. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression (SAINT-TRD) proved the efficacy and safety of accelerated TBS protocol for depression. In this clinical trial, 21 participants with TRD received 50 iTBS sessions as 10 daily sessions over 5 consecutive days. Amazingly, 19 of 21 participants (90.48%) met the criteria for remission immediately after SAINT. In the intent-to-treat analysis, 19 of 22 participants (86.4%) met the remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. This supported that accelerated iTBS was well tolerated and safe. Efficacy was surprisingly high. 


    A randomized controlled trial called SNT was conducted to validate this effect. It confirms the efficacy of the SAINT TMS protocol. I discussed the findings in detail in a blog post that you can refer to here in this link.


    Florida Accelerated TMS Program

    Florida TMS Clinic has been providing accelerated TMS since 2019. We share some of our findings in an abstract published in Brain Stimulation which you can read via this link. We are working on a larger project publishing the results of all the aiTBS cases we did in the last 3 years. 


    Florida TMS Clinic offers non-MRI navigated accelerated intermittent theta burst stimulation to select patients. Florida TMS Clinic doesn’t use fcMRI-guided targeting at this time. Magnus Medical is working hard on producing a SAINT TMS device. Florida TMS Clinic is reaching out to Magnus Medical to obtain the most advanced TMS therapy options for our patients in Tampa Bay and internationally.


    If you have questions related to Florida Accelerated TMS, please call 813-867-2378

    

    Share by: