Accelerated Theta Burst Stimulation Dropped Depression Scores by Two-Thirds in Just Five Days, a Penn Medicine Randomized Trial Found

Brain stimulation for bipolar depression typically takes four to six weeks. This new study suggests five days might be enough.

Researchers at the University of Pennsylvania’s Perelman School of Medicine tested an accelerated form of repetitive transcranial magnetic stimulation called intermittent theta burst stimulation, or aiTBS. They enrolled 24 patients with treatment-resistant bipolar depression. The results, published in JAMA Psychiatry, showed a striking difference.

Active treatment: depression rating scores dropped from 30.4 to 10.5. That’s a 65 percent reduction. The sham group barely budged. 28.0 to 25.3.

The protocol was intensive: 10 sessions per day over five consecutive days. One session per hour. Standard TMS requires daily sessions spread over four to six weeks. That schedule creates a real barrier for patients who cannot take that much time away from work or daily life.

This accelerated format compresses weeks of treatment into less than a week. The study was led by Yvette I. Sheline, MD. And the results suggest this could open access to bipolar patients who haven’t responded well to medications or cannot tolerate their side effects.

That group is not small. Bipolar depression is where patients spend the most time. It drives disability and suicide risk. Treatment options remain limited. Many antidepressants are ineffective or risky because they can trigger mania or rapid cycling.

The aiTBS approach uses magnetic pulses directed at specific mood regulation brain regions. It’s already FDA-approved for major depression. But this is the first accelerated trial specifically for bipolar depression.

Let’s be clear about the limitations. Sample size: 24 participants. Longer-term durability of the response: not yet established. Larger trials are needed before aiTBS becomes standard. But the magnitude of the response in this initial study is notable.

A note from Liam Ronan: When you are in the middle of bipolar depression, six weeks feels like a lifetime. The idea that something could work in five days, without the risk of triggering mania, I think is the kind of development that gives people real hope.

For more information, visit NAMI’s bipolar disorder resource page or the Depression and Bipolar Support Alliance.

Sources: Penn Medicine | JAMA Psychiatry

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