New Stanford SAINT protocol showing 90% remission rates — what it means for patients
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Sign in to commentThis is fascinating. 5 days instead of 6 weeks would be life-changing for people who can't take extended time off work. Any idea when this might become more widely available? I'm in the midwest and I doubt anyone near me offers it yet.
Great summary, Dr. Wong. I'll add that several academic medical centers are now offering SAINT or SAINT-like protocols. The main barriers to wider adoption are the fMRI requirement (not every clinic has access) and the intensive staffing needed for 10 sessions per day. We're seeing some clinics offer a modified version — accelerated TMS over 1-2 weeks without the fMRI targeting — which is a middle ground that's more accessible.
Do the 90% remission rates hold up long-term? Or is it possible that the accelerated approach wears off faster? I'd rather do 6 weeks if the results last longer.
David — that's the key question researchers are working on. The initial follow-up data shows durability comparable to standard TMS at 6 months, but we need more long-term studies. There's no evidence that accelerated delivery leads to faster relapse. In theory, the precise targeting might actually improve durability since you're stimulating exactly the right circuit.
The MRI-guided targeting is the secret sauce, not the dose schedule. That's what most clinics offering 'SAINT-equivalent' are missing.
SAINT is incredible but the cost is the issue — most clinics offering it are charging $20-30k out of pocket since insurance is still catching up.
Did accelerated (3 sessions/day, 10 days) at a clinic that uses neuronavigation. Out of pocket but I got 7 weeks of treatment compressed into 2 weeks. Game changer for someone with limited PTO.
Insurance reality check: BCBS just added accelerated TMS to their coverage policy for treatment-resistant depression. Slow but it's coming.
I did SAINT-equivalent (5 sessions/day for 5 days) at a clinic in Texas. It worked but the intensity was rough — not for everyone.
The downside no one mentions: when SAINT works, it works fast — but the rebound risk if you don't have maintenance set up is higher. Have a plan.
Stanford's published 1-year follow-up data was less rosy than the headline. Real durability looks closer to standard TMS at 12 months. Still effective, just not magical.
The 90% number is from a small RCT. Real-world numbers are closer to 60-70% which is still huge vs ~50% standard.
Asked four clinics in my city — none use real fMRI targeting yet. Calling that out matters because it's the part that drives the 90% number.
My insurance just approved accelerated TMS (3 sessions/day) which is a step toward SAINT pricing. Things are moving fast.
Friend just finished SAINT-style at a research site for free. Remission at week 1. Will report back at month 6.