What If SAINT® Doesn't Work for Me?

SAINT® (Stanford Accelerated Intelligent Neuromodulation Therapy) is FDA-cleared for major depressive disorder (MDD) in adults whose depression has not improved enough on prior antidepressant medication. But SAINT® does not work for everyone. In the 2022 randomized controlled trial, 79% of participants reached remission — which means about 21% did not (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary. Not reaching remission after one course is not the end of the road.

If SAINT® doesn't produce enough relief, the next steps may include continued follow-up, a repeat SAINT® course, or other treatments — all available at the same clinic. NWCOA, a Verified SAINT® Provider in Coral Springs, Florida, offers SPRAVATO® (esketamine), ketamine, medication management, and psychotherapy alongside SAINT®, so you don't get sent to another provider. Learn more about SAINT® or check if you're a candidate.

Remission means your depression scores drop below a certain threshold on a standardized mood scale. Not reaching remission after one SAINT® course does not mean you got no benefit at all. Some people improve partially — their symptoms ease but don't fully resolve. Others don't notice a change. The treatment team uses standardized scales to measure your response objectively, not just how you feel on a given day.

The 79% remission figure from the 2022 trial is encouraging, but it also means that about 1 in 5 participants didn't reach that threshold with one course (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary. That's why the follow-up plan and the range of next-step options matter. A partial response or no response is a signal to adjust the plan, not a reason to give up.

Not everyone who responds to SAINT® feels better by the end of the fifth day. Some people notice improvement in the days or weeks after the treatment week ends. The brain continues to adjust after the stimulation stops, and mood can continue to lift even after the sessions are over.

This is why the follow-up period is part of the protocol, not an afterthought. The treatment team tracks your mood with standardized scales during the weeks after SAINT® so they can tell the difference between a delayed response and a need for a different approach.

If you reach the end of the week and don't feel different, don't assume the treatment failed. The team monitors you closely and helps you understand what to expect next. A delayed response is not uncommon, and the follow-up visits are designed to catch it. See what happens after SAINT®.

After the five-day SAINT® week, the treatment team schedules follow-up visits to track your response. They use standardized mood scales — the same kinds of scales used in the clinical trials — to measure how your symptoms change over days and weeks.

If you're not improving, the team reviews your symptoms and discusses next steps. This might mean adjusting your current medication, considering a repeat SAINT® course, or exploring a different treatment type. The follow-up plan is a checkpoint, not a dead end. Your psychiatrist looks at the full picture — your mood scores, your side effects, your overall function — before recommending a change.

The team also watches for any side effects or changes in mood during follow-up. If your mood drops or you have thoughts of suicide, tell the team right away. If you are in crisis, call or text 988. Verify your insurance benefits if you're considering next steps.

A repeat SAINT® course may be an option if your initial response is partial — you improved but didn't reach remission — or if relief wears off over time. Whether a repeat course makes sense depends on your individual response, your symptoms, and your psychiatrist's assessment.

The five-day protocol stays the same, but the targeting may be adjusted based on your response to the first course. Your psychiatrist reviews your mood scores and your overall progress before recommending a repeat. SAINT® at NWCOA starts at $25,000; coverage varies by plan and we verify your benefits for free. Check your eligibility to see if a repeat course is an option for you.

One advantage of getting SAINT® at NWCOA is that if it doesn't produce enough relief, you don't get sent to another clinic. SPRAVATO® (esketamine), ketamine, medication management, and psychotherapy are all offered in the same place, by the same team that already knows your history. You don't start over with a new provider — you continue with the team that treated you.

SPRAVATO® (esketamine) is an FDA-approved nasal spray for treatment-resistant depression in adults. It's administered in-office under the SPRAVATO® REMS program, typically over several weeks of scheduled visits. Compare SAINT® and SPRAVATO®.

Ketamine is another option. IV ketamine for depression is used off-label — the FDA has not approved it specifically for depression, but doctors may use it based on clinical evidence. It's typically given as a series of infusions over a few weeks. Compare SAINT® and ketamine.

Medication management is ongoing. Your psychiatrist can adjust your current medications, try new ones, or fine-tune your regimen based on how you responded to SAINT®. Sometimes a medication change after SAINT® makes a meaningful difference, especially if the treatment uncovered a new pattern in your symptoms.

Psychotherapy — including cognitive behavioral therapy and other approaches — can be used alongside any of these treatments or on its own. It's often part of a broader plan for managing depression long-term, especially after an acute treatment like SAINT®.

Each option has its own evidence, timeline, and insurance pathway. Coverage varies by plan. We verify your benefits for free, whatever carrier you have. Learn about treatment-resistant depression to understand where each option fits.