Question for the clinicians/researchers here — is the funded course a budget limit rather than a clinical maximum?
So in Australia we get 35 funded sessions (~36 in a lot of US protocols), and from what I've read that number seems to be a funding decision, not where the evidence says benefit stops. A few things I came across:
The standard research protocol was 30 sessions plus a taper.
One study found 15.7% only started responding after session 30.
A big registry (7,000+ patients) found benefit kept climbing past 36 with no plateau.
Among non-responders who continued past 36, over half eventually responded.
So for those who do this clinically: do you tell patients the funded course is a floor, not a ceiling? And how do you tell a likely late responder (worth extending) from someone who needs a protocol change?
Asking because I suspect a lot of people read a non-response as "TMS doesn't work for me" and stop — when for some it might just be under-dosing.
(Happy to link the studies.)