TMS vs. SAINT®: Which Depression Treatment is Right for You?

Key Takeaways

• Traditional TMS and SAINT are both non-invasive brain stimulation treatments used for depression, but they differ in pace, targeting and treatment structure.
• Traditional TMS is delivered in short outpatient sessions over 4-6 weeks. SAINT is delivered in an accelerated 5-day course.
• SAINT uses structural and functional MRI to personalize the stimulation target based on each person’s brain connectivity. Traditional TMS follows a more standard outpatient treatment map.
• The right option between SAINT vs. TMS depends on symptom severity, urgency, treatment history, schedule availability and clinician evaluation.

If you are exploring non-invasive treatment options for depression, you may have come across both traditional Transcranial Magnetic Stimulation (TMS) and SAINT® therapy. At first glance, they can seem similar because both use magnetic stimulation and are used to treat depression. The important differences are in how treatment is targeted, how quickly it is delivered and which patients may be better suited for each treatment approach. Understanding the differences between SAINT vs. TMS can help you as you speak to your doctor about the best treatment plan for you and your mental health.

What is SAINT?

SAINT, which stands for Stanford Accelerated Intelligent Neuromodulation Therapy, is an FDA-cleared, rapid-acting outpatient treatment for major depressive disorder (MDD) in adults who have not improved with prior antidepressant treatment. It is the first neuropsychiatric treatment to use functional Magnetic Resonance Imaging (fMRI) to identify a personalized treatment target in the brain, then deliver an accelerated series of short neuromodulation sessions daily for five days.

Brandon Bentzley, M.D., Ph.D., chief medical officer and the lead developer of SAINT at the Stanford Brain Stimulation Lab, explains that depression is increasingly understood as a disorder of brain circuitry rather than a simple chemical imbalance. In many people with depression, the dorsolateral prefrontal cortex (DLPFC) in the brain is often underactive while the subgenual anterior cingulate cortex (sgACC) in the brain becomes overactive, reinforcing negative self-directed thought patterns. SAINT was developed to help restore healthier communication between these two regions by identifying the exact DLPFC target most strongly connected to the sgACC and stimulating it with focused neuromodulation.^[1]  

SAINT is delivered in 10 short sessions a day for five consecutive days, with rest breaks between sessions. This accelerated structure is proven to help patients feel improvement much faster. In landmark clinical trials, 79% of patients with MDD or treatment-resistant depression achieved remission of their depression, on average in just 2.6 days.

What is Traditional TMS?

Traditional TMS, or transcranial magnetic stimulation, is also an FDA-cleared, non-invasive treatment used for depression and certain other conditions. During treatment, a magnetic coil is placed on the patient’s scalp to stimulate brain regions that are involved in a person’s mood regulation. Unlike antidepressant medications, TMS does not work through the whole body, and unlike electroconvulsive therapy (ECT), it does not require anesthesia.

A standard treatment plan of traditional TMS is usually delivered as an outpatient treatment, once a day, five days a week, for four to six weeks. Sessions typically last 20-40 minutes. That slower, steadier structure can be a better fit for people who want a treatment they can incorporate into their normal routine while still pursuing a non-invasive therapy that is often effective when medication alone has not been enough.

How SAINT and Traditional TMS Differ

The biggest differences between SAINT and traditional TMS include the timeline, anatomical targeting and the treatment intensity. Traditional TMS follows a more standard outpatient model, with short daily sessions over several weeks. SAINT treatment is performed in just five days.

The two treatments are also different in how they target the brain. Traditional TMS begins with scalp mapping and treatment setup, then proceeds through a standard course of stimulation using focused magnetic pulses delivered through a coil placed on the scalp to stimulate the prefrontal cortex. This helps to “reset” the neural pathways that are involved in mood regulation and wellness.^[2]

SAINT goes further by using structural and resting-state functional MRI to identify the exact spot in the DLPFC that is most strongly connected to the sgACC. That individualized targeting is one of the clearest ways SAINT is different. SAINT neuromodulation helps the brain build healthier patterns of connectivity, with many people noticing improvement in days instead of weeks or months.

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How Clinicians Decide Which Treatment May Fit Best

When patients ask whether SAINT vs. TMS is more effective, the better question is usually which treatment is more appropriate for the individual person. Clinicians consider factors such as depression severity, how urgently relief is needed, prior antidepressant response, history of treatment resistance, medical and psychiatric context, and whether the patient can realistically commit to a standard outpatient schedule or if an intensive five-day course is more appropriate. When depression is acute and suicidal ideation is part of the clinical picture, the speed of response matters, which is one reason some clinicians evaluate SAINT as a treatment option.

There are also situations where doctors may lean toward TMS because it works well as an add-on to medication rather than a replacement for it. Dr. Mohammed Ahmed, M.D., clinical director for Salma Health, explains that TMS is often used alongside antidepressants in people who have only a partial benefit from medication. He describes TMS as creating a “therapeutic window” in which people may think more clearly, feel more energy and re-engage with daily life as symptoms begin to lift.  Furthermore, TMS may also be part of a care plan for someone who is suffering from generalized anxiety disorder complicated by depression, obsessive-compulsive disorder, PTSD, and certain persistent symptoms after traumatic brain injury, including major depression and post-traumatic headache.

SAINT vs. TMS for Depression

Both SAINT and traditional TMS play an important role in depression care. At Salma Health, the goal is to understand the person clearly and recommend the treatment most likely to help them with their current conditions at this stage of life. This assessment is based on individual symptoms, personal treatment history, urgency and everyday life realities. If you are considering treatment for depression, the next step is a careful clinical evaluation.

Salma Health offers both TMS and SAINT at its multiple locations. You can learn more about TMS and  SAINT therapies, Salma Health’s comprehensive intake process and its clinic locations worldwide as you explore your options. To discuss your personal brain healthcare journey with a clinician, please reach out to Salma Health today.

^[1] https://pubmed.ncbi.nlm.nih.gov/34711062/

^[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6738665/