SAINT (Stanford Neuromodulation Therapy): What It Is and Is Not

SAINT, now also called Stanford Neuromodulation Therapy (SNT), is an accelerated form of TMS for depression developed at Stanford. It combines two things: a stimulation target in the left dorsolateral prefrontal cortex chosen individually from each patient's MRI scans, and a compressed schedule of 10 intermittent theta-burst sessions a day for 5 days. FDA cleared it in September 2022 for adults with major depression who have not improved on antidepressant medication in the current episode.

SAINT is not the same as any accelerated TMS, and the striking "90% remission" figure often quoted for it comes from a 22-person open-label study. Its controlled evidence is one early-stopped, single-site trial of 29 patients. The results are impressive and the evidence base is still small, both of which a patient should know before paying for it.

What SAINT is

FDA's clearance summary defines "SAINT Technology" as "the combination of using the specific individualized target for treatment along with a proprietary accelerated treatment protocol that condenses treatment to five days". Both halves are required. The parts of a SAINT course:

1. Imaging. Before treatment, the patient has structural and functional MRI. Software analyzes resting-state connectivity to find the part of the left DLPFC most strongly anticorrelated with the subgenual anterior cingulate cortex.
2. Dosing. The motor threshold is measured by watching finger movement with EMG, and the intensity is adjusted for the depth of the frontal target. Treatment runs at 90% of resting motor threshold.
3. Treatment days. Ten iTBS sessions a day of 1,800 pulses each, about 10 minutes apiece, separated by 50-minute intervals, for 5 days. The coil is positioned by neuronavigation.

The scale of the dose is the striking part. Compared with a standard 6-week iTBS course, SAINT delivers 50 vs 30 sessions and 90,000 vs 18,000 pulses, in 5 days instead of 6 weeks. The biology behind the target is described in how TMS works, and methods of locating it in TMS targeting and neuronavigation.

The trial evidence, with the numbers

In the controlled trial, the primary outcome, MADRS change four weeks after treatment, was a 52.5% average reduction with active treatment vs 11.1% with sham. There were no serious adverse events, and the open-label study found no negative effects on neuropsychological testing.

Those are very large effects for a depression trial. The limitations are equally important:

• Small numbers. The controlled evidence is 29 people. Trials stopped early for benefit can overestimate the true effect.
• Blinding. Only 19 of the 29 completed the blinding questionnaire, and FDA noted that "uncertainty remains as to the adequacy of the blinding".
• One site. All 70 patients in the FDA submission came from studies at a single site, so "generalizability to the broader United States population has not been evaluated".
• Short follow-up. Effectiveness "has not been established beyond the timepoints evaluated", which was four weeks after treatment. A 2025 consensus statement also calls for more studies of long-term durability.

Why remission rates differ so much between studies is explained in response vs remission.

Does the MRI targeting matter?

SAINT's targeting rests on a 2012 analysis showing that DLPFC sites with better reported outcomes were more anticorrelated with the subgenual cingulate. Whether choosing that spot for each patient improves results has been tested since, with mixed findings:

• BRIGhTMIND (2024), with 255 patients, found connectivity-guided iTBS no better than MRI-navigated standard rTMS over 26 weeks.
• A 2026 trial of 40 adults found connectivity-based targeting of accelerated TMS beat scalp-based targeting, with a median MADRS drop of 24 vs 18 points; the paper has since carried two correction notices.
• A 2026 trial of 123 patients found an early advantage for connectivity-guided targeting that faded by week 12.
• A 2025 sham-controlled trial of accelerated iTBS without any neuronavigation (100 patients, 45 sessions over 15 weekdays) still found response of 52% vs 22%.

The fair conclusion is that accelerated iTBS appears to work with or without individualized targeting, and that personalized targeting may add something, but how much is not settled.

What SAINT is not

It is not "SAINT-inspired" accelerated TMS

Many clinics now offer accelerated iTBS schedules that resemble SAINT. Some are on firm regulatory ground: MagVenture's accelerated TMS system, cleared in May 2026 with SAINT as its primary predicate, covers 2 to 10 sessions a day with or without functional MRI targeting. But a course without the Magnus individualized target and protocol is not SAINT as FDA defined it, and the SAINT trial results do not automatically transfer to it.

The wider landscape is in accelerated TMS explained and theta burst stimulation.

It is not "FDA-approved", and not the only cleared accelerated option

SAINT was cleared through a traditional 510(k), not approved, and was not granted through De Novo. Its stimulator hardware is MagVenture equipment. BrainsWay's accelerated deep TMS (2025) and MagVenture's accelerated system (2026) are also cleared.

It is not cleared for other conditions or ages

The clearance covers adults with major depression only. FDA records show no later SAINT label expansion, and Magnus has said OCD, bipolar depression and postpartum depression are being studied in trials, not cleared.

It is not a one-day treatment or a crisis treatment

Single-day protocols that pair TMS with medications are a different, uncleared approach; see one-day accelerated TMS. And although SAINT works quickly in trials, people with acute suicidal ideation or psychotic symptoms should be considered for treatments with established efficacy, such as ECT. Research on rapid relief of suicidal thoughts is reviewed in TMS and suicidal thoughts. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Availability, cost and coverage

SAINT was cleared in 2022 but "only became commercially available in 2024", according to the 2025 consensus statement. Because it requires the Magnus system and MRI-based planning, availability depends on which centers have invested in both, and waits and travel can be part of the decision.

It has its own billing codes: 0889T for target development and 0890T to 0892T for treatment days. Medicare's 2026 hospital outpatient payment is $950.50 for target development and $3,750.50 per treatment day; these are hospital outpatient rates, not office-based prices. A clinic-published cost article lists SAINT courses at $30,000 to $36,000, but it is a commercial source and gives no method, so treat it as a rough indication only.

Commercial coverage is limited. Aetna lists SAINT as experimental and does not cover its codes, Cigna considers SAINT and SNT experimental, and UnitedHealthcare lists accelerated and MRI-guided theta-burst protocols as unproven. Patients considering it should get a written benefits determination before scheduling. The patient guide to accelerated TMS coverage explains how to ask.

What a SAINT week involves

The five treatment days are demanding. With ten roughly 10-minute sessions separated by 50-minute breaks, a treatment day lasts most of a working day. Patients spend the gaps between sessions waiting at the center. Fatigue was common in the controlled trial, reported by 57% of the active group, and so was back or neck pain, at 50%. Planning matters: time off work, transport to and from the center each day, and someone to check in with in the evenings.

The imaging and target planning happen before the first treatment day. After the fifth day, there is no built-in maintenance schedule in the cleared protocol, so follow-up depends on the treating team. Ask how progress will be measured in the weeks afterward and what the plan is if symptoms return; for durability of TMS in general, see how long TMS results last.

Who might consider SAINT

SAINT is cleared for adults with major depression who have not improved on antidepressant medication in the current episode, the same broad indication as standard TMS. Within that group, it may be worth discussing for people who cannot manage six weeks of daily visits, who want the fastest available TMS option and can pay for it, and who can undergo MRI. It is a less natural fit for someone whose plan covers standard TMS but not SAINT, for someone who has already responded well to standard TMS, or for anyone with psychotic symptoms, for whom other treatments are better supported.

Questions to ask before choosing SAINT

• Is this SAINT on the Magnus system, or a different accelerated protocol?
• Who reviews the MRI-based target, and what happens if the scan cannot be used?
• What follow-up is planned after the five days, and what is the plan if symptoms return?
• What is the total cost, including imaging, and has insurance confirmed in writing what it will pay?
• Given my history, is standard TMS, esketamine or ECT a better-supported option? Comparisons are in treatment-resistant depression options compared.

The full series is in the TMS guide, and the TMS therapy page covers TMS as part of psychiatric care.

Frequently asked questions

What does SAINT stand for?

Stanford Accelerated Intelligent Neuromodulation Therapy. The protocol is now also called Stanford Neuromodulation Therapy (SNT). It was developed at Stanford and is commercialized by Magnus Medical.

Is SAINT really 90% effective?

The 90% figure is remission in 19 of 21 people who completed an open-label study with no control group. In the only sham-controlled trial, 11 of 14 active patients remitted vs 2 of 15 on sham. Both studies were small and from a single site, so real-world rates may be lower.

How long do SAINT results last?

This is not yet known. FDA's clearance summary says effectiveness was evaluated only up to four weeks after treatment.

Is SAINT covered by insurance?

Usually not by commercial insurers. Aetna, Cigna and UnitedHealthcare policies reviewed in 2026 classify SAINT or accelerated MRI-guided theta burst as experimental or unproven.

Can I get SAINT without an MRI?

Not as FDA defined it. SAINT requires an individualized target from MRI. Accelerated theta-burst courses without MRI targeting exist, and some are FDA-cleared, but they are a different protocol.

Sources

1. K220177 510(k) Summary: Magnus Neuromodulation System with SAINT Technology. U.S. FDA, 2022. accessdata.fda.gov
2. openFDA 510(k) records, applicant Magnus. U.S. FDA (openFDA), 2026. api.fda.gov
3. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. American Journal of Psychiatry, 2020. pubmed.ncbi.nlm.nih.gov
4. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. American Journal of Psychiatry, 2022. pubmed.ncbi.nlm.nih.gov
5. Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clinical Neurophysiology, 2025. doi.org
6. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. Biological Psychiatry, 2012. pubmed.ncbi.nlm.nih.gov
7. Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nature Medicine, 2024. pubmed.ncbi.nlm.nih.gov
8. Connectivity- vs Scalp-Based Targeting of Accelerated Transcranial Magnetic Stimulation for Depression: A Randomized Clinical Trial. JAMA Psychiatry, 2026. jamanetwork.com
9. Individualized Connectivity-Guided Versus Conventional Targeting of Accelerated Theta-Burst Stimulation in Depression: A Randomized, Double-Blind, Parallel-Design Trial. American Journal of Psychiatry, 2026. pubmed.ncbi.nlm.nih.gov
10. Accelerated Theta-Burst Stimulation for Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry, 2025. pmc.ncbi.nlm.nih.gov
11. K260189 510(k) Summary: MagVenture Accelerated TMS (aTMS) Therapy System. U.S. FDA, 2026. accessdata.fda.gov
12. MagVenture Receives FDA Clearance for Accelerated TMS Protocols, Expanding Flexibility for Clinics and Patients. MagVenture (press release), 2026. magventure.com
13. Dose-response associations of total pulse dose and intersession interval with clinical outcomes in accelerated rTMS for major depressive episodes: A systematic review and meta-analysis. Brain Stimulation, 2026. pubmed.ncbi.nlm.nih.gov
14. Accelerated intermittent theta-burst stimulation for major depressive episodes: systematic review and dose-response meta-analysis. Brain Stimulation, 2026. pubmed.ncbi.nlm.nih.gov
15. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet, 2018. pubmed.ncbi.nlm.nih.gov
16. Clinical TMS Society's Statement on Level of Evidence for Single-Day TMS combined with Medications. Clinical TMS Society, 2025. clinicaltmssociety.org
17. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry, 2018. pmc.ncbi.nlm.nih.gov
18. Addendum B: OPPS Payment by HCPCS Code for CY 2026 (October 2026). Centers for Medicare & Medicaid Services, 2026. cms.gov
19. Transcranial Magnetic Stimulation for Treating Physical Health Conditions (2026T0536W). UnitedHealthcare, 2026. uhcprovider.com
20. How Much Does TMS for Depression Cost?. Cognitive FX (clinic blog; commercial source), 2026. cognitivefxusa.com
21. Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
22. Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com

Educational information, not medical advice. Whether TMS or any treatment fits you is a decision to make with a psychiatrist who knows your history.