Same equipment (BrainsWay Deep TMS), same target (the left dorsolateral prefrontal cortex), same psychiatrist behind the protocol. What changes is the timeline and the technique. Standard TMS uses 20–30 minute sessions, one per day, five days a week, for about seven weeks. Accelerated TMS uses theta burst stimulation — shorter 9.5-minute sessions, ten per day, across five consecutive days. The total course is 50 sessions either way; accelerated just delivers them in a week.

Standard TMS is FDA-cleared, and most commercial and government insurers cover it. The accelerated 5-day delivery schedule is a clinical modification of that protocol — it isn't separately FDA-cleared, and insurers don't yet authorize it. The technique itself (theta burst stimulation) is FDA-approved as a TMS protocol; the compressed schedule is what's outside reimbursement. We don't submit this to insurance because they'll decline.

Most responders begin to notice changes by Day 3 or 4 of the protocol, with continued improvement over the following two to four weeks. A portion of patients don't respond — Dr. Blair tracks neuropsychological assessments across the week and will be direct with you at the midpoint and the final review about what the data shows. Published research on accelerated TMS protocols, including the Stanford SAINT study (Cole et al., 2020), reports high remission rates; individual response varies, and we won't guarantee a specific outcome.

Yes. TMS isn't appropriate for patients with a history of seizures or with non-removable metallic implants in or near the head -pacemakers, cochlear implants, aneurysm clips, deep brain stimulators, and similar. Standard dental fillings are fine. Dr. Blair screens for all of this at the consultation, and if TMS isn't safe for you, he'll say so and discuss alternatives.

Optimum's accelerated TMS is informed by the body of accelerated TMS research, including the Stanford SAINT study, but it isn't clinically identical to that specific protocol. Our protocol uses the BrainsWay H-coil rather than the figure-8 coil used in SAINT, and there are differences in session sequencing. We won't market our service under the SAINT name because the protocols aren't the same treatment.

The days are long — typically 7:30am to 5pm or 5:30pm. Treatment sessions themselves aren't physically tiring; you're reclining for the 9.5 minutes of each session. What's more demanding is the sustained attention across the day and the cumulative effect of the protocol. Most patients report mild fatigue by Day 4 or 5, especially if traveling, and benefit from quiet evenings during the week.

Yes — out-of-state patients make up a meaningful portion of our accelerated TMS visits. The initial consultation can be done by video before you travel. We can recommend hotels within walking distance or a short drive from the clinic. You can drive yourself between the hotel and clinic each day. The week is structured so you arrive Sunday evening and leave Friday evening if you want a clean five-day block.

Yes. The same contraindications apply as for standard TMS: a history of seizures, non-removable metallic implants in or near the head (pacemakers, cochlear implants, aneurysm clips, deep brain stimulators), active psychosis, or active manic episodes. Standard dental work like fillings is fine. Dr. Blair or a psychiatric nurse practitioner screens for all of this at the consultation. If accelerated TMS isn't safe for you, we'll say so and discuss alternatives.

Optimum is led by Dr. Mark Blair, an ABPN board-certified psychiatrist with over 24 years in practice. He's a US Air Force veteran, founded Optimum TMS in 2017, and personally oversees every patient's treatment plan. Initial consultations are conducted by Dr. Blair or one of our psychiatric nurse practitioners.