The largest replication to date of the Stanford SAINT protocol, published this week in the American Journal of Psychiatry, found that 79% of patients with treatment-resistant depression achieved remission within four weeks of completing the five-day intensive course. The 158-patient study spanned six academic medical centers in the United States and Canada.
SAINT compresses 50 sessions of intermittent theta burst stimulation into five days, with personalized targeting using resting-state functional MRI to identify each patient's antidepressant network node in the left dorsolateral prefrontal cortex. Patients in the trial had failed an average of 4.2 prior antidepressant trials before enrolling.
Lead investigator Dr. Nolan Williams, who developed the original protocol at Stanford, told reporters that the consistency across sites is what matters most. "The original 2020 trial was widely cited but everyone wanted to see whether the effect would survive outside Stanford. It did."
Adverse events were limited to transient scalp discomfort and headache. No seizures were reported. Durability remains the open question — about a third of remitters had relapsed by six months and required maintenance sessions.
Health systems are watching closely because the five-day format makes accelerated TMS practical for patients who cannot commit to six weeks of daily clinic visits. Several large insurers are expected to revise their accelerated TMS coverage policies in the coming quarters.
Source
Reporting based on coverage from American Journal of Psychiatry. This article is editorial summary intended for general information; it is not medical advice.