Talk:Transcranial magnetic stimulation

SAINT Protocol

Hi, I wanted to share some important recent developments and distinctions regarding the accelerated TMS protocol known as SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy), which may warrant its own linked article in the near future, as well as a clearly defined section within the existing TMS page.

SAINT has demonstrated substantially higher efficacy than the older standard rTMS protocols still widely used. While traditional TMS typically involves one session per day over several weeks, SAINT delivers ten sessions per day for five consecutive days, spaced approximately 50 minutes apart to align with the brain’s plasticity window. It uses about five times the total stimulation dose of standard TMS, approximately 90,000 pulses compared to 18,000, and, more importantly, employs individualized targeting based on functional MRI and algorithmic analysis. This allows stimulation of a specific subregion of the left dorsolateral prefrontal cortex uniquely optimized for each patient, often the area most strongly anti-correlated with the subgenual anterior cingulate cortex, a region implicated in major depression.

By contrast, standard TMS protocols use a generalized target site, typically based on the so-called five centimeter rule, without individualization. SAINT’s precision, intensity, and optimized timing make it fundamentally distinct from conventional TMS rather than simply a faster version.

In terms of efficacy, early research, particularly from the Stanford team, has reported remission rates as high as 79 to 90 percent, even in patients who had not responded to medications or standard TMS. This contrasts with typical remission rates around 30 percent or lower for standard TMS.

SAINT represents an evolution of traditional TMS. Until recently, it was not covered by insurance and was only available out-of-pocket, often costing over $30,000. As of January 1, 2025, Medicare and, in some cases, Medicaid have begun covering SAINT when administered in hospital outpatient settings, with a reimbursement amount of approximately $19,703 for a full course of treatment. However, coverage remains limited; Medicaid coverage varies by state, and private insurers largely consider SAINT experimental and do not cover it. Consequently, many patients, particularly younger individuals and those without Medicare or applicable Medicaid coverage, face significant financial barriers. There is hope this will change as further data emerges and awareness grows.

This therapy is among the most promising and effective treatments currently available for clinical depression. While research has primarily focused on individuals with treatment-resistant depression, interest is growing in its earlier use due to rapid onset and high remission rates. Many patients find that although standard antidepressants reduce the most severe symptoms, they often do not fully restore well-being. Some experience residual emptiness or adverse side effects, including paradoxical worsening of mood. Compared to these options, SAINT offers a noninvasive, fast-acting alternative that may also be safer and better tolerated than electroconvulsive therapy, which is associated with risks such as memory loss and other cognitive side effects.

Patient-reported outcomes indicate benefits extending beyond clinical measures. Many individuals describe the treatment as life-changing and even life-saving, expressing profound relief, renewed motivation, and restored hope. Some have shared heartfelt gratitude, often reflecting on how the therapy helped them regain a meaningful quality of life and an appreciation for what lies ahead. Importantly, SAINT has demonstrated minimal cognitive side effects, underscoring its value in clinical practice.

Given these factors, it seems worthwhile to consider creating a separate linked article for this innovative, life-saving treatment while maintaining a concise section within the broader TMS article. While I’m currently too busy and tired to write a full article myself, I hope to contribute more detailed edits when I’m able. In the meantime, contributions from anyone else who’d like to help expand or improve this content would be very welcome.

Additionally, it would be helpful if someone could compile a current list of clinics offering the exact SAINT protocol developed at Stanford and commercialized by Magnus Medical, as practical information for patients is important. To my knowledge, fewer than ten clinics in the United States provide this treatment as of now.

Cheers, SaltySemanticSchmuck (talk) 18:42, 4 July 2025 (UTC)

Any WP:MEDRS ? Bon courage (talk) 18:43, 4 July 2025 (UTC)