Where TMS Is Headed: Accelerated Protocols, Access, and the Next Decade

TMS is moving in a consistent direction: faster protocols, smaller and more workflow-friendly hardware, more flexible ways to pay for equipment, and delivery in more settings than the large, specialized centers that historically dominated the field. None of these shifts are guaranteed to play out on any particular timeline, and this piece does not claim to predict one. But the direction is visible enough in how manufacturers are designing systems and how practices are adopting them that it is worth describing plainly, along with where Ampa fits into that trajectory.

From daily six-week courses toward accelerated delivery

The clearest trend in TMS is the shift away from a single daily session sustained for roughly six weeks and toward accelerated protocols that compress a full course into days rather than weeks. This shift is enabled by theta-burst stimulation, which delivers a therapeutic dose in a session lasting a few minutes rather than the 20-plus minutes older protocols require. Once a single session is that short, delivering several in a day becomes practical, and a six-week course can be compressed dramatically. That has downstream effects beyond convenience: it changes which patients can realistically commit to treatment, how many treatments a practice can deliver per room, and what hardware needs to do between sessions to keep pace. We expect accelerated delivery to keep gaining share relative to the traditional daily protocol, not because the daily protocol stops being valid, but because a compressed option removes the single biggest reason patients decline treatment in the first place: the time commitment. For a deeper look at why this matters for a practice specifically, see Accelerated TMS as a Practice Differentiator.

From cart-based hardware toward compact, workflow-first systems

Much of the TMS hardware in wide use today was designed years ago around a daily-session model, and it shows in the footprint: large carts, dedicated rooms, and setup routines built around doing one thing once a day. As accelerated protocols become more common, hardware built for a different cadence has to be adapted rather than optimized. The direction of travel is toward more compact systems designed for repeated setup and targeting within a single day — because a device that has to reset and re-target several times in an afternoon is under different design pressure than one that does so once. We expect this pressure to keep pushing new systems toward smaller footprints, faster session-to-session turnaround, and targeting workflows (like camera-based neuronavigation) that are fast enough to use every session rather than reserved for occasional use.

From capital purchases toward subscription and lease models

TMS acquisition has historically mirrored other capital medical equipment: a large upfront purchase, or a pay-per-use arrangement that trades a low entry cost for a fee owed on every session indefinitely. Neither model is well suited to a field where the addressable base of potential providers is much larger than the number of large, well-capitalized centers that have historically dominated it. The broader trend across medical equipment — and one already visible in TMS — is toward subscription and leasing structures that lower the capital bar to start a program while keeping ongoing costs predictable and margins intact. That shift matters more for TMS than for many device categories, because a practice's economics are so sensitive to how many sessions a full course requires; a per-session fee compounds across 30-plus sessions in a way it would not for a single-visit procedure. See TMS Business Models and ROI for how the lease-versus-buy-versus-pay-per-use math actually works out.

From large specialized centers toward broader practice settings

TMS has long been concentrated in centers built specifically around it — often the only realistic place for a practice to send patients needing daily sessions for six weeks, given the equipment and space commitment involved. As accelerated protocols shorten the course and leasing models lower the entry cost, the economics of offering TMS change for smaller and more general psychiatric and primary behavioral health practices, not just specialized centers. We expect the setting where a patient receives TMS to broaden over time — not because large centers stop mattering, but because the practical requirements for offering it well are becoming achievable for a wider range of practices. That broadening is also what closes the access gap for patients who currently have to travel to a specialized center rather than being treated somewhere closer to their existing care relationships.

Where Ampa fits

Ampa was built anticipating this direction rather than reacting to it. Ampa One is compact and built around the ONE-D accelerated protocol as a first-class use case, includes camera-based neuronavigation rather than treating it as an add-on, and is offered on a lease with no per-session fees. Each of those design choices maps directly onto one of the shifts described above: accelerated-first design, a workflow-friendly footprint, a subscription business model, and a lower bar for practices beyond the largest centers to add TMS. We do not think every practice needs to adopt accelerated protocols or leasing models to succeed with TMS — but we do think the field is moving in that direction, and we built Ampa to fit where it is going rather than where it has been.

What this means for a practice deciding when to act

None of this requires a practice to wait for some future state to start offering TMS; accelerated protocols, compact hardware, and lease-based acquisition are already available today, not hypothetical improvements years out. The more useful question for a practice is not whether these trends will continue, but whether the specific system and business model it chooses now is built for where the field is going or for where it has already been. A system designed around a daily six-week protocol and a large upfront purchase is a reasonable choice if that is genuinely what a practice needs, but it is worth being deliberate about that choice rather than defaulting to it out of familiarity.

Frequently Asked Questions

Is accelerated TMS going to replace standard daily TMS? Not necessarily entirely, but accelerated protocols are gaining adoption because they remove the biggest reason patients decline treatment: the six-week time commitment. Expect accelerated options to keep growing as a share of how TMS is delivered, alongside the standard protocol rather than immediately displacing it.

Why are TMS devices getting smaller and more compact? Accelerated protocols require setting up and re-targeting multiple times within a single day, which puts different design pressure on hardware than a once-daily session does. Compact, fast-to-reset systems are better suited to that cadence than legacy cart-based equipment designed for a single daily use.

Why is leasing becoming more common for TMS equipment? Leasing lowers the capital barrier to starting a program and keeps ongoing costs predictable, which matters more in TMS than in many device categories because a full course involves 30-plus sessions — a per-session fee compounds significantly over that volume.

Will TMS become available outside large specialized centers? The trend points that direction. As protocols compress the treatment timeline and acquisition models lower the entry cost, more general psychiatric and behavioral health practices — not just dedicated centers — are positioned to add TMS.

‍How is Ampa positioned relative to these trends? Ampa One was designed around an accelerated-first protocol, a compact footprint, included neuronavigation, and a lease-based model with no per-session fees — choices that align with the broader direction the field is moving in rather than the historical model of TMS delivery.