What Is SAINT® TMS? The SAINT Protocol Explained

SAINT® — Stanford Accelerated Intelligent Neuromodulation Therapy — is an accelerated form of transcranial magnetic stimulation (TMS) for major depressive disorder. It was developed at the Stanford Brain Stimulation Lab and is delivered commercially on the Magnus Neuromodulation System with SAINT Technology, made by Magnus Medical, Inc.

What sets the SAINT protocol apart is how compressed it is. Standard TMS takes one session a day for four to six weeks. SAINT® delivers ten short sessions a day for five consecutive days — 50 sessions in one week — each using an intermittent theta burst stimulation (iTBS) pulse pattern, with roughly 50-minute breaks between sessions.

The 2022 randomized trial published in the American Journal of Psychiatry referred to the treatment as Stanford Neuromodulation Therapy (SNT). SAINT® and SNT describe the same protocol. The FDA-cleared commercial system is the Magnus Neuromodulation System with SAINT Technology (510(k) K220177), and it is available only through clinics credentialed by Magnus Medical.

People sometimes misspell the name — “st. cloud transcranial magnetic stimulation” or “saint therapy” — but the correct full name is Stanford Accelerated Intelligent Neuromodulation Therapy. If you see SNT, SAINT, or the Magnus Neuromodulation System with SAINT Technology, they all refer to the same FDA-cleared treatment described on this page.

The SAINT protocol has four parts: brain imaging, personalized targeting, the five-day treatment week, and follow-up. Here is what each involves.

• Brain imaging: You have a structural MRI (a detailed 3D map of your brain's anatomy) and a resting-state functional MRI (fMRI), which measures how different brain regions communicate while you lie still. No injections or dyes are involved.
• Personalized targeting: Magnus Medical's software analyzes your fMRI to find a precise spot in the left dorsolateral prefrontal cortex (DLPFC) \u2014 specifically, the point whose activity is most strongly anticorrelated with the subgenual anterior cingulate cortex (sgACC), a region involved in mood regulation.
• The treatment week: Over five consecutive days, you receive 10 sessions of iTBS per day. Each session is about 10 minutes of stimulation, followed by a 50-minute break. That adds up to 50 sessions and roughly 90,000 magnetic pulses total.
• Follow-up: After the week, your clinician tracks your mood scores and coordinates any next steps with you and, if you have one, your referring provider.

The protocol and the system can't be separated. The FDA clearance (510(k) K220177, September 2022) covers the protocol together with the Magnus system's targeting software \u2014 the personalized fMRI-guided targeting is part of what the FDA cleared. For more on the targeting step, see our guide to fMRI-guided TMS for depression, and for what each day looks like, our page on what happens between SAINT\u00ae sessions.

SAINT® works by combining three elements that distinguish it from conventional TMS: functional MRI targeting, intermittent theta burst stimulation (iTBS), and an accelerated schedule.

• Functional MRI targeting \u2014 a brain scan identifies each patient's individualized stimulation site based on their own brain connectivity, instead of a population-average scalp measurement.
• Intermittent theta burst stimulation (iTBS) \u2014 a pulse pattern delivering bursts of 3 pulses at 50 Hz, about 1,800 pulses per 10-minute session. The THREE-D trial showed iTBS was non-inferior to conventional 10 Hz TMS when delivered once daily (Blumberger et al., Lancet 2018).
• Accelerated schedule \u2014 10 sessions per day for 5 consecutive days, with roughly 50-minute breaks between sessions, totaling 50 sessions in one week.

Before your treatment week, you have a psychiatric evaluation and a resting-state fMRI. The scan maps how your prefrontal cortex communicates with deeper mood circuits, and proprietary software calculates your individual stimulation target in the left DLPFC. During the week, neuronavigation holds the coil on that exact target for every session. No anesthesia or sedation is used, and you are awake throughout.

The table below compares the SAINT® protocol with standard TMS and with fMRI-guided accelerated TMS that does not use the SAINT system, so you can see the differences at a glance.

Full comparison: SAINT\u00ae vs. traditional TMS side by side.

Treatment-resistant depression is typically defined as major depressive disorder that has not responded adequately to at least two antidepressant trials of adequate dose and duration. SAINT®'s FDA-cleared indication covers adults in this situation, though the final determination of eligibility is made by a psychiatrist after a clinical evaluation.

Learn more about treatment-resistant depression and who qualifies for SAINT\u00ae.

In the 2020 open-label study, 19 of 21 completers (90.5%) met remission criteria after five days, but there was no sham comparison. In the 2022 double-blind, sham-controlled randomized trial, 78.6% of the active group (11 of 14) reached remission at four weeks compared with 13.3% (2 of 15) of the sham group (Cole et al., Am J Psychiatry 2022;179(2):132–141).

Both studies were small and conducted at a single site, and follow-up was short (four weeks in the randomized trial). The results should be read as promising early evidence rather than definitive. No trial has compared SAINT\u00ae head-to-head with a standard six-week TMS course. Individual results may vary. For a deeper look at the data, see our SAINT\u00ae results page.

The most common side effects are headache, scalp discomfort, and facial muscle twitching, which usually lessen over the first day or two. The most serious risk is seizure, which is rare. Over-the-counter pain relief is often enough for headaches; tell your treatment team about any discomfort so coil position or intensity can be adjusted.

People with ferromagnetic metal in or near the head (such as cochlear implants or aneurysm clips), implanted electronic stimulators, or who cannot have an MRI are not candidates. A history of seizures requires careful evaluation. SAINT\u00ae is not FDA-cleared for bipolar depression, PTSD, anxiety disorders alone, OCD, or anyone under 18. See is SAINT\u00ae safe?.

Some clinics market a lower-cost “fMRI-guided accelerated TMS” program that copies the five-day schedule but uses their own, non-cleared targeting off-label. Because those programs were not part of the SAINT clinical trials and do not use the Magnus Medical system, they cannot claim SAINT®'s trial results or FDA clearance.

Neuro Wellness TMS Centers of America is listed on Magnus Medical's official provider locator. Learn how to verify a SAINT\u00ae provider and read our SAINT\u00ae disclaimer.

SAINT\u00ae at Neuro Wellness starts at $25,000 for the full five-day course, including the fMRI scan and all 50 sessions. Medicare has a payment rate for SAINT\u00ae. Commercial coverage is limited and decided case by case through prior authorization, which is why we verify your benefits for free before you commit. See SAINT\u00ae cost & insurance or check my insurance options.