The SAINT TMS Protocol, Step by Step
The SAINT® protocol delivers 50 sessions of intermittent theta burst stimulation (iTBS) over five consecutive days: 10 sessions a day, each about 10 minutes long, with 50-minute breaks in between. Before treatment, an fMRI scan identifies a personalized target in the left dorsolateral prefrontal cortex, and neuronavigation keeps the coil on that target every session. The full course replaces the six to nine weeks of standard TMS.
Key takeaways
- SAINT® delivers 50 sessions of intermittent theta burst stimulation over five consecutive days.
- Each day has 10 sessions of about 10 minutes, with 50-minute breaks between them.
- An fMRI scan identifies a personalized target in the left dorsolateral prefrontal cortex.
- Neuronavigation keeps the coil on your exact target every session.
- The full course replaces the six to nine weeks of standard TMS.
Step 1: Consultation and screening
A clinician reviews your diagnosis, medication history, other treatments you've tried, and medical history. You'll complete standard questionnaires such as the PHQ-9. You'll also be screened for contraindications, including non-removable metal in or near the head and implanted devices.
Step 2: Brain imaging
You'll have two types of MRI. No injections or dyes are involved.
- Structural MRI creates a detailed 3D map of your brain's anatomy.
- Resting-state functional MRI (fMRI) measures how different brain regions communicate while you lie still.
Step 3: Personalized targeting
Magnus Medical's software analyzes your fMRI to find a precise spot in the left dorsolateral prefrontal cortex (DLPFC). Specifically, it looks for the point whose activity is most strongly anticorrelated with the subgenual anterior cingulate cortex (sgACC), a deeper region that tends to be overactive in depression.
In plain terms: it finds the place on the surface of your brain that has the most leverage over the deeper region driving your symptoms. This location differs from person to person, which is why standard TMS, which uses skull measurements instead, can miss it.
Step 4: Motor threshold and dosing
On your first treatment day, the team finds your resting motor threshold: the lowest stimulation level that makes your thumb twitch. Your treatment dose is set relative to that number and adjusted for the depth of your target.
Step 5: The five-day treatment week
| Element | SAINT protocol |
|---|---|
| Days | 5 consecutive days, typically Monday–Friday |
| Sessions per day | 10 |
| Session length | About 10 minutes of stimulation |
| Break between sessions | 50 minutes |
| Total sessions | 50 |
| Stimulation pattern | Intermittent theta burst stimulation (iTBS) |
| Pulses per session | 1,800 |
| Total pulses | 90,000 |
| Coil guidance | Neuronavigation to your fMRI target |
Treatment days run about 10 hours. Between sessions you can rest, read, eat, work on a laptop, or walk around. You're awake and alert the whole time, with no anesthesia. Afterward, you can drive.
Why the 50-minute gap?
The spacing is deliberate. Research behind SAINT found that the brain's response to theta burst stimulation builds when sessions are spaced roughly an hour apart. That timing is part of what lets SAINT compress weeks of treatment into days.
Step 6: Follow-up
Your care team tracks your symptoms during and after the treatment week. Many patients notice changes within days. If symptoms return later, repeat SAINT treatment is an option, and Magnus Medical has studied personalized continuation treatment for people who responded initially.
How the SAINT protocol differs from other accelerated TMS
Some clinics offer accelerated TMS with multiple sessions per day. The SAINT protocol is distinct because it combines all of these: fMRI-personalized targeting, neuronavigation, iTBS at high total dose, and 50-minute spacing over five days. Only Verified SAINT Providers deliver it. Learn more about what SAINT treatment for depression is.
What to do next
Understanding the protocol is the easy part. Knowing whether it fits your history is what a consultation is for.
Neuro Wellness TMS Centers of America is a Verified SAINT Provider in Coral Springs, Florida. We'll walk you through your scan, your treatment week, and what to expect, step by step.
Frequently Asked Questions
How many sessions are in the SAINT protocol?
Fifty: 10 per day for five days.
How long is each SAINT session?
About 10 minutes of stimulation, followed by a 50-minute break.
What part of the brain does SAINT target?
A personalized spot in the left dorsolateral prefrontal cortex, chosen for its connection to the subgenual anterior cingulate cortex.
Does the SAINT protocol require anesthesia?
No. You're awake throughout and can drive afterward.
Can the protocol be spread out over more days?
The FDA-cleared protocol is five consecutive days. That's how it was studied and how it's delivered.
Cited Research
- 1. Cole EJ, et al. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry. 2022;179(2):132–141.
- 2. Cole EJ, et al. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. 2020;177:716–726.
- 3. U.S. Food and Drug Administration. 510(k) Premarket Notification — Magnus Neuromodulation System with SAINT Technology (K220177, September 2022).
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
SAINT® Accelerated TMS
The 5-day, fMRI-guided protocol offered at our clinic
What Is SAINT® TMS?
FDA clearance, protocol, and evidence
Find a Verified SAINT® Provider
How to verify a SAINT® provider
What Happens During SAINT®
Day-by-day guide to the five-day protocol
SAINT® vs Traditional TMS
How SAINT compares to standard TMS
Schedule a Consultation
Book a free consultation with our clinical team