Related Experiment Video
Updated: Mar 25, 2026
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
Pilot Study of Accelerated Low-Frequency Right-Sided Transcranial Magnetic Stimulation for Treatment-Resistant
Phern-Chern Tor1, Verònica Gálvez, James Goldstein
1From the *Department of General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, Singapore; †School of Psychiatry, University of New South Wales, Randwick, Sydney, New South Wales, Australia; ‡Black Dog Institute, Randwick, Sydney, New South Wales, Australia; and §Department of Psychiatry, St George Hospital, Level 2, James Laws House, Sydney, New South Wales, Australia.
Background:
Repetitive transcranial magnetic stimulation (rTMS) is an effective option for treatment-resistant depression but requires prolonged repeated daily treatments for 4 to 6 weeks. Pilot studies have showed the possibility of accelerating rTMS safely and efficaciously but thus far only investigated high-frequency left-sided rTMS. We sought to investigate the safety and efficacy of accelerated low-frequency right-sided rTMS.
Methods:
Our study was an open label accelerated rTMS pilot in 7 treatment-resistant patients (4 unipolar, 3 BP). Accelerated rTMS was given over the right dorsolateral prefrontal cortex at 120% of resting motor threshold at 1 Hz, and 900 pulses were delivered per session. A single rTMS treatment was administered on the first day to test for tolerability, followed by 5 rTMS sessions a day for 2 days, then 7 days of daily rTMS sessions. The total course consisted of 16,200 pulses across 18 sessions given over 10 consecutive weekdays. The primary outcomes of interest were self- and clinician-rated depression scores (BDI-II and MADRS).
Results:
All patients successfully and safely completed the accelerated rTMS treatment. MADRS scores decreased significantly by the third day of treatment and BDI II scores by the end of the 10-day treatment. No patients achieved response or remission.
Conclusions:
Accelerated low-frequency right-sided rTMS was a safe and possibly efficacious treatment for treatment-resistant depression. More research is recommended, including a controlled trial with longer duration of exposure, to establish the efficacy of left- and right-sided accelerated rTMS.
