Advanced Depression Treatment Options
Advanced depression treatments are options for people whose depression hasn't responded to standard first-line treatments like antidepressants and psychotherapy. These include TMS (transcranial magnetic stimulation), SAINT® accelerated TMS, SPRAVATO® (esketamine), medication augmentation, and ECT. These treatments work through different mechanisms than oral antidepressants and are FDA-cleared or approved for treatment-resistant depression. The appropriate advanced treatment depends on your clinical history and should be determined by a psychiatrist.
Key takeaways
- Advanced treatments are for depression that hasn't responded to standard care.
- TMS and SAINT® use magnetic brain stimulation.
- SPRAVATO® works through NMDA receptor modulation.
- ECT is the most effective for severe or psychotic depression.
- The appropriate treatment is determined by a psychiatrist.
What Makes a Treatment 'Advanced'
Advanced depression treatments are options used when standard first-line treatments — antidepressant medication and psychotherapy — haven't produced adequate relief. These treatments work through different mechanisms than oral antidepressants: brain stimulation (TMS, SAINT®, ECT) or different chemical pathways (SPRAVATO®/esketamine). They are typically considered after at least two adequate antidepressant trials have failed.
Advanced does not mean experimental. TMS, SAINT®, SPRAVATO®, and ECT are all FDA-cleared or approved treatments with evidence supporting their use for specific indications.
TMS (Transcranial Magnetic Stimulation)
TMS is FDA-cleared for adults with major depressive disorder who haven't improved on antidepressants. It uses magnetic pulses to stimulate the left dorsolateral prefrontal cortex. A standard course is about 36 sessions over six weeks. TMS is non-invasive, requires no anesthesia, and is broadly covered by insurance for treatment-resistant depression.
SAINT® Accelerated TMS
SAINT® is an accelerated TMS protocol — 50 sessions in five days with fMRI-guided targeting. It is FDA-cleared (K220177) for adults whose depression hasn't improved on antidepressants. In a sham-controlled trial, 79% of the active group reached remission. SAINT® is the fastest FDA-cleared depression treatment protocol.
SPRAVATO® (Esketamine)
SPRAVATO® is an FDA-approved nasal spray for treatment-resistant depression. It works through NMDA receptor modulation — a different mechanism than standard antidepressants. It is administered in-office under monitoring, typically twice weekly during the induction phase. SPRAVATO® may be an option for patients who haven't responded to oral antidepressants.
ECT (Electroconvulsive Therapy)
ECT uses electrical stimulation under general anesthesia to induce a controlled seizure. It has the highest remission rates for severe, psychotic, or catatonic depression (often 50-70% or higher). ECT requires hospital-based treatment and can cause memory side effects. It is typically reserved for the most severe or urgent cases.
Medication Augmentation
Medication augmentation involves adding a second medication to an existing antidepressant — such as atypical antipsychotics, lithium, or thyroid hormone. This can enhance the effectiveness of the primary antidepressant. Augmentation is an advanced medication strategy that should be managed by a psychiatrist.
Understanding SAINT® TMS: How It Works & What to Expect
SAINT® is an FDA-cleared treatment for adults with major depressive disorder who have not improved on antidepressants in the current episode. These videos explain how it works and how it differs from conventional TMS.
SAINT® is an FDA-cleared, fMRI-guided form of TMS developed at Stanford. Most patients complete treatment in one week — not the six weeks standard TMS requires.
Follow a real patient through the five-day SAINT® treatment week
Is SAINT® TMS Right for You?
Tried antidepressants without enough relief? SAINT® TMS is an FDA-cleared, fMRI-guided treatment for adults with major depressive disorder who have not improved enough with antidepressant medication.
SAINT® uses a personalized brain target and delivers treatment over five consecutive days. It differs from standard TMS in its targeting approach, treatment schedule, and research background. In a small randomized trial, 11 of 14 people receiving active treatment reached remission at the four-week assessment, compared with 2 of 15 receiving sham treatment. Results vary, and a five-day treatment course does not guarantee remission in five days.
How SAINT® Works and How It Differs From Conventional TMS
SAINT® is an FDA-cleared treatment for adults with major depressive disorder who have not improved on antidepressants in the current episode. This video explains how it works, and how it differs from conventional TMS.
Conventional TMS usually means about 30 visits over 6 to 9 weeks. SAINT is five visits over five days.
What makes it different: SAINT is the only FDA-cleared depression treatment that uses an fMRI scan to personalize the stimulation target to your individual brain. A 45-minute scan maps your brain and identifies the specific circuit linked to depression. Treatment is then delivered as ten 10-minute sessions per day, with 50-minute breaks between them, across five consecutive days.
In clinical trials, 79% of participants reached remission, with an average of 2.6 days to remission. SAINT is generally well tolerated; the most common side effects reported were mild headache and temporary scalp discomfort at the treatment site.
SAINT® at Neuro Wellness TMS Centers of America
Coral Springs, Florida
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Call or Text: 954-827-9793
Sources: Cole et al., American Journal of Psychiatry 2020;177:716-726 and 2022;179(2):132-141. magnusmedical.com/depression-therapy. PubMed 34711062. FDA 510(k) K220177.
Insurance coverage for SAINT is currently limited and varies by plan. Individual results may vary. This video is educational and is not medical advice. Talk to a qualified clinician about whether SAINT is appropriate for you. If you are in crisis, call or text 988.
Frequently Asked Questions
What are advanced depression treatments?
Advanced treatments are options for depression that hasn't responded to standard care (antidepressants and therapy). They include TMS, SAINT® accelerated TMS, SPRAVATO® (esketamine), medication augmentation, and ECT. These work through different mechanisms than oral antidepressants and are FDA-cleared or approved.
When should I consider advanced depression treatment?
Advanced treatments are typically considered after at least two adequate antidepressant trials have failed. If you've tried multiple medications without success, a psychiatric evaluation can determine whether advanced treatments like TMS, SAINT®, or SPRAVATO® are appropriate for you.
Is SAINT an advanced depression treatment?
Yes. SAINT® is an accelerated TMS protocol for treatment-resistant depression. It is FDA-cleared and delivers 50 sessions in five days with fMRI-guided targeting. In a sham-controlled trial, 79% of the active group reached remission. SAINT® is the fastest FDA-cleared depression treatment protocol.
Are advanced depression treatments covered by insurance?
TMS is broadly covered for treatment-resistant depression when criteria are met. SPRAVATO® is often covered for its FDA-approved indications. SAINT® coverage varies by plan; many patients self-pay. ECT is generally covered. Coverage varies by plan — verify your benefits.
What is the most effective advanced depression treatment?
ECT has the highest remission rates for severe or psychotic depression. For treatment-resistant depression, TMS, SAINT®, and SPRAVATO® all have evidence supporting their use. The most effective treatment for you depends on your clinical history and circumstances. No single treatment is universally best.
Cited Research
SAINT® is delivered only by verified providers on the Magnus Medical system. Programs described as SAINT “alternatives”, “equivalents” or “fMRI-guided accelerated TMS” are not SAINT®, are not affiliated with us, and SAINT® results do not apply to them. Read our SAINT® disclaimer.
Have questions about whether TMS may be appropriate for you?
Speak with our clinical team. A free consultation is the best way to get answers specific to your situation.
Related Patient Education
When Treatment Isn't Working
What to do when depression treatment isn't working
SAINT® Accelerated TMS
The 5-day, fMRI-guided protocol for treatment-resistant depression
What Is Treatment-Resistant Depression?
Definition, causes, and treatment options
When Antidepressants Don't Work
What to do when medication isn't enough
Depression Treatment Beyond Medication
Non-medication options for depression
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