How Long Does SAINT® Last? Results, Relapse & Maintenance

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. After the five-day treatment week, the question most people ask is: how long do the results last? The honest answer is that long-term durability data are still limited. The 2022 randomized controlled trial followed participants for four weeks after treatment (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary.

Open-label follow-up data suggested that some people maintained improvement for months, while others saw symptoms return and were retreated. A maintenance plan — which may include continuing or adjusting medication, engaging in psychotherapy, scheduling follow-up visits, and considering a repeat course if needed — is an important part of treatment. NWCOA, a Verified SAINT® Provider in Coral Springs, Florida, coordinates follow-up care and offers SPRAVATO®, ketamine, medication management, and psychotherapy in the same clinic. Learn more about SAINT® or check if you're a candidate.

In the immediate days and weeks following the five-day SAINT® course, patients typically enter a monitoring phase. Some experience noticeable symptom relief before the treatment week ends; for others, the response unfolds over the subsequent 1 to 4 weeks as neural circuits adapt.

Your treatment team schedules follow-up check-ins — often at 1 week, 2 weeks, and 4 weeks post-treatment — using standardized depression rating scales (like MADRS or PHQ-9) to track your progress objectively. During this window, you continue working with your home psychiatrist or therapist, take any ongoing medications as directed, and avoid abrupt changes to your care routine without clinical guidance.

If you traveled for treatment, your follow-up check-ins with Neuro Wellness are coordinated with your home providers. Telehealth follow-up visits are available for established Florida patients. If you notice early warning signs of low mood returning during the weeks after treatment, notify your care team immediately.

The most widely cited SAINT® data come from the 2022 double-blind randomized controlled trial by Cole et al., published in the American Journal of Psychiatry. In that study, 79% of participants reached remission after the five-day protocol, and participants were followed for four weeks after treatment (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary.

Earlier open-label studies by Cole et al. (2020) and other Stanford research groups followed participants for longer periods. These open-label data suggested that many people who initially responded maintained improvement for several months, but some relapsed and were retreated. Because open-label studies do not have a control group, they are less rigorous than the randomized trial, but they provide the best available signal about durability.

The key takeaway is that the randomized trial — the strongest evidence — only followed participants for four weeks. Longer-term durability is inferred from open-label data, not from a long-term randomized study. Your psychiatrist can discuss what the current evidence does and does not cover for your individual situation.

Several factors may influence how long the benefits of SAINT® last. These include your individual biology, the severity and duration of your depression, whether you continue medication and psychotherapy after treatment, and whether you have a strong follow-up plan in place.

Depression is a condition that can recur. No treatment — whether medication, psychotherapy, TMS, or SAINT® — guarantees permanent remission. What a good treatment does is put you in remission and give you a plan to stay there. The maintenance plan is what helps sustain the gains.

People who continue working with a psychiatrist and therapist after SAINT®, who take any prescribed medications consistently, and who attend follow-up visits are better positioned to catch a relapse early and address it before it becomes severe. The follow-up plan is not an afterthought — it is part of the treatment.

If you have a home psychiatrist or therapist, a follow-up plan with your home providers should be arranged before you leave. NWCOA coordinates follow-up care, which may be done in person or via telehealth for established patients in Florida. Verify your insurance benefits if you are planning your follow-up.

Relapse means depression symptoms return after a period of improvement. It does not mean SAINT® failed — it means the depression returned, which is a known feature of the condition. The earlier you catch a relapse, the more options you have.

Warning signs to watch for include: a gradual return of low mood or sadness; loss of interest or pleasure in activities you had been enjoying; sleep changes — sleeping too much or too little; fatigue or low energy; difficulty concentrating or making decisions; feelings of worthlessness or guilt; withdrawal from social contact; and any thoughts of suicide or self-harm.

If you notice these changes, contact your treatment team right away. Do not wait for your next scheduled follow-up if symptoms are returning. Early intervention — whether a medication adjustment, a repeat SAINT® course, or a different approach — can help. If you are in crisis or having thoughts of suicide, call or text 988 immediately. The 988 Suicide and Crisis Lifeline is available 24/7, free and confidential.

If you are in crisis or having thoughts of suicide, call or text 988 right now. The 988 Suicide and Crisis Lifeline is available 24/7.

A maintenance plan after SAINT® may include several components. Continuing or adjusting antidepressant medication is common — your psychiatrist reviews your medication regimen based on how you responded to SAINT® and may fine-tune it. Engaging in psychotherapy, such as cognitive behavioral therapy, can help you maintain the gains and build skills for managing depression long-term. Scheduling follow-up visits with your psychiatrist allows the team to track your mood with standardized scales and catch any changes early.

Maintenance TMS — periodic follow-up sessions after an initial course — is another option for some people. Whether maintenance TMS is appropriate is a clinical decision made with your psychiatrist. Note that some insurance plans classify maintenance or continuation TMS as investigational, which may affect coverage. Coverage varies by plan; we verify your benefits for free. Learn about TMS maintenance.

SAINT® can be repeated if depression returns. A new fMRI may be obtained to recompute the target, or the original target may be used. The decision to repeat treatment is made by your psychiatrist based on your response, the time since the first treatment, and the overall clinical picture. SAINT® at NWCOA starts at $25,000; coverage varies by plan and we verify your benefits for free.

If SAINT® doesn't produce enough relief or symptoms return, other options are available at the same clinic — SPRAVATO® (esketamine), ketamine, medication management, and psychotherapy. You don't get sent to another provider. See what to do if SAINT® doesn't work or check your eligibility.