Accelerated TMS responder

After a successful accelerated TMS course, mood peaks and holds for months — then, around month 4, drops suddenly over about a week. A silent relapse with no missed appointments and no crisis, the kind a quarterly check-in misses entirely.

TMS, week 5 of 6

The full-responder pattern: pre-treatment baseline, clear gains in week 1, then continued improvement across the course to a durable response that holds with natural day-to-day variation.

TMS — course complete

The 20–30% who plateau early: a modest week-1 gain, then improvement flattens below remission. The signal to augment rather than keep waiting for a response that won't come.

Lithium + atypical

180 days of monitoring through a complete bipolar I cycle: euthymic baseline, prodromal upswing, manic episode, rapid switch, depressive episode, slow recovery.

Divalproex + atypical

A single, sustained mixed episode: low, dysphoric mood held down for weeks while agitation and irritability run high. The depression-plus-activation signature stands out on the emotional map, not as up-and-down swings.

Esketamine — induction

Fast 24–72h onset, then a plateau after week 1, then steady improvement as dosing continues on schedule (twice-weekly month 1, weekly month 2) — with a mild, expected dip between doses.

Esketamine — maintenance

Responds, then the effect wanes on every-other-week maintenance. The rising symptoms are caught and dosing is stepped back up to weekly — and the response recovers. The dose-optimization story.