Successful Deep Transcranial Magnetic Stimulation (dTMS) After Failure of rTMS, ECT, and Ketamine in Refractory Treatment-Resistant Depression: Real-World Case Series

however, conventional once-daily treatment schedules present significant logistical barriers for many patients.Methods: We report the first documented case of successful treatment of persistent AH in schizoaffective disorder using a one-day accelerated TMS protocol.A 43-year-old woman with schizoaffective disorder experienced chronic, distressing auditory hallucinations refractory to antipsychotic treatment, with further medication optimization limited by adverse effects.Due to travel and time constraints, she consented to a single-day, neuronavigated accelerated cTBS intervention targeting the left TPJ, augmented with D-cycloserine.The protocol consisted of 20 cTBS sessions delivered at 30-minute intervals (600 pulses per session; total 12,000 pulses) at 80% resting motor threshold, guided by individualized neuronavigation.Results: Treatment was well tolerated with no adverse effects.The patient reported resolution of auditory hallucinations by the end of the treatment day.Symptom improvement was reported by substantial reductions in standardized clinical measures.Hallucinations remained absent at follow-up assessments up to 16 weeks posttreatment, with sustained functional stability.Discussion: This case suggests that a single-day, precisionguided, neuroplasticity-augmented TMS protocol may be a safe and feasible option for medication-refractory auditory hallucinations, with potential durability of benefit.Accelerated approaches may improve accessibility when standard regimens are impractical, though confirmation in larger controlled studies is needed.