Effects of H-coil TMS on suicidality in major depression: A secondary analysis of data from a multisite randomized trial comparing accelerated to once-a-day stimulation
In brief
Accelerated H-coil TMS speeds relief of suicidal thoughts in major depression
In a multicenter trial, both accelerated intermittent theta-burst and standard high-frequency deep TMS lowered suicidal ideation, but the accelerated schedule produced meaningful improvement several days earlier. The faster drop in suicidality appeared even before overall depressive symptoms resolved, suggesting that higher-frequency dosing may be valuable for patients needing rapid anti-suicidal effects, though larger studies are still needed.
- Journal
- Journal of affective disorders (Q1)
- Published
- 21 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yiftach Roth, Aron Tendler, Eliza Brink, Molly Davis, Aftab Khan, Timothy Prestley, et al.
- PMID
- 42628575
- DOI
- 10.1016/j.jad.2026.122409
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (top studies of the week, 11 October 2026): secondary analysis of H‑coil TMS impact on suicidality in MDD
Abstract
Suicide is the 10th leading cause of death in US adults. Standard once-daily repetitive transcranial magnetic stimulation (rTMS) can reduce suicidal ideation. Yet, antidepressant and anti-suicidal effects often take several weeks to emerge, while rapid improvement is often required. Accelerated TMS has been proposed as a strategy to hasten therapeutic response. A recent FDA-regulated multicenter trial evaluated accelerated intermittent theta burst Deep TMS with the H1-coil versus standard high-frequency Deep TMS in MDD. Both groups demonstrated high remission and response rates for depression, with the accelerated protocol showing non-inferiority and a shorter time to remission. The goal of this exploratory secondary analysis was to evaluate the impact of these two H-coil TMS dosing paradigms on suicidal ideation. The Scale for Suicide Ideation (SSI), as well as suicidality items of HDRS, MADRS and CUDOS were collected and analyzed. On all scales, both accelerated and standard Deep TMS protocols were associated with meaningful reductions in suicidality. The accelerated protocol achieved a faster onset of improvement. Comparison between the timeline of improvement in suicidality and in overall depressive symptoms found a trend for faster improvement in suicidality, especially with the accelerated protocol. These findings highlight the importance of treatment frequency in determining time to clinical benefit and support the use of scalable accelerated protocols for patients requiring more rapid symptom relief.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.