New Treatments for Treatment-Resistant Depression
Recent treatments for treatment-resistant depression include SAINT® accelerated TMS (FDA-cleared September 2022), SPRAVATO® (esketamine, FDA-approved as monotherapy January 2025), and advances in theta burst stimulation. These treatments work through different mechanisms than standard antidepressants and offer new options for people whose depression hasn't responded to medication. 'Newer' does not mean 'better' for every person — each has specific indications, risks, and evidence limits. A psychiatric evaluation can determine which is appropriate for you.
Key takeaways
- SAINT® was FDA-cleared in September 2022.
- SPRAVATO® was approved as monotherapy for TRD in January 2025.
- These work through different mechanisms than standard antidepressants.
- 'Newer' does not mean 'better' for every person.
- A psychiatric evaluation determines which is appropriate.
SAINT® Accelerated TMS
SAINT® (Stanford Accelerated Intelligent Neuromodulation Therapy) was FDA-cleared in September 2022 (510(k) K220177) for adults with major depressive disorder who haven't improved on antidepressant medication. It delivers 50 sessions in five days with fMRI-guided targeting. In a sham-controlled trial, 79% of the active group reached remission vs 13% of sham. SAINT® is the newest FDA-cleared TMS protocol and the fastest depression treatment protocol available.
SPRAVATO® (Esketamine)
SPRAVATO® was first FDA-approved in 2019 for treatment-resistant depression (with an oral antidepressant). In January 2025, it was approved as monotherapy (without an oral antidepressant) for treatment-resistant depression. SPRAVATO® works through NMDA receptor modulation — a different mechanism than standard antidepressants. It is administered as a nasal spray in-office under monitoring.
Theta Burst Stimulation
Intermittent theta burst stimulation (iTBS) was FDA-cleared in 2018 as a once-daily TMS protocol. The THREE-D trial (2018) showed iTBS is non-inferior to standard 10 Hz TMS, with much shorter sessions (3 minutes vs 37 minutes). iTBS is the pulse pattern used in SAINT®. Theta burst represents an advance in TMS delivery, making treatment faster and more efficient.
'Newer' Does Not Mean 'Better'
Newer treatments offer additional options, but they do not automatically mean better outcomes for every person. Each treatment has specific indications, risks, evidence limits, and cost considerations. SAINT® has strong early evidence but small studies with short follow-up. SPRAVATO® causes dissociation and requires in-office monitoring. The appropriate treatment depends on your individual circumstances and should be discussed with 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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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 the newest treatments for treatment-resistant depression?
Recent treatments include SAINT® accelerated TMS (FDA-cleared 2022), SPRAVATO® as monotherapy (approved 2025), and theta burst stimulation. These work through different mechanisms than standard antidepressants. 'Newer' doesn't mean 'better' for every person — each has specific indications and risks.
Is SAINT TMS a new treatment?
SAINT® was FDA-cleared in September 2022, making it the newest FDA-cleared TMS protocol. It delivers 50 sessions in five days with fMRI-guided targeting. In a sham-controlled trial, 79% of the active group reached remission. It is the fastest FDA-cleared depression treatment protocol.
Is SPRAVATO a new treatment?
SPRAVATO® was first approved in 2019 (with an oral antidepressant) and as monotherapy in January 2025. It works through NMDA receptor modulation — a different mechanism than standard antidepressants. It is administered as a nasal spray in-office under monitoring.
Are newer depression treatments better?
Not necessarily. Newer treatments offer additional options but don't automatically mean better outcomes. Each has specific indications, risks, evidence limits, and cost considerations. The appropriate treatment depends on your individual circumstances and should be discussed with a psychiatrist.
What is the fastest treatment for treatment-resistant depression?
SAINT® is the fastest FDA-cleared depression treatment protocol — 50 sessions in five days. In the open-label study, average time to remission was 2.6 days. However, individual results vary, and the studies were small with short follow-up. SAINT® may be appropriate for treatment-resistant depression when a faster timeline is desired.
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
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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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