SAINT TMS: The 5-Day Depression Treatment That's Changing Psychiatry

In August 2024, the FDA cleared SAINT - Stanford Accelerated Intelligent Neuromodulation Therapy - as a distinct treatment protocol. In July 2025, Medicare assigned it a reimbursement rate of $19,703 per course. This is one of the most significant developments in depression treatment in years, and most patients have never heard of it. **What Is SAINT TMS?** SAINT is an accelerated form of repetitive transcranial magnetic stimulation (rTMS) developed at Stanford University by Dr. Nolan Williams and his team. Standard TMS requires 36 sessions delivered once daily over 6–9 weeks. SAINT compresses that into 10 sessions per day for 5 consecutive days - a full course in one week. The results from the Stanford trials were striking. In the initial 2021 study published in the American Journal of Psychiatry, 78.6% of participants with severe treatment-resistant depression achieved remission after SAINT - compared to 13% in the sham (placebo) group. Remission, not just response - meaning symptoms dropped below the clinical threshold for depression entirely. More recent real-world data has shown more modest but still meaningful results, with remission rates in the 40–60% range in broader populations. These numbers still dramatically exceed standard antidepressant outcomes in treatment-resistant patients. **How SAINT Differs From Standard TMS** Three key differences: *Speed.* Standard TMS is 36 sessions over 6–9 weeks. SAINT is 10 sessions per day for 5 days. For patients who've been suffering for years, compressing treatment from months to a week is clinically and logistically significant. *Targeting.* SAINT uses fMRI-guided targeting to identify the specific subregion of the left dorsolateral prefrontal cortex (DLPFC) most connected to the subgenual anterior cingulate cortex - a region strongly implicated in depression. Standard TMS uses a standardized target location. The individualized targeting is believed to improve efficacy. *Intensity.* SAINT delivers intermittent theta burst stimulation (iTBS), a pattern of magnetic pulses that achieves results faster than the standard pulse patterns used in traditional TMS. **Who Is SAINT For?** SAINT was developed specifically for treatment-resistant depression - patients who have not adequately responded to antidepressants. The original trials enrolled patients with severe, chronic, treatment-resistant MDD. Many had been ill for years and had tried multiple medications without adequate relief. It is not typically a first-line treatment. Most patients pursuing SAINT have already tried antidepressants, and often other interventions. The compressed timeline makes it particularly attractive for patients who: - Cannot take 6–9 weeks off work or other obligations for standard TMS - Need rapid relief (active suicidal ideation, severe impairment) - Have already tried standard TMS without full response - Want the most effective evidence-based option available **Insurance Coverage for SAINT TMS in 2026** Medicare began covering SAINT TMS in July 2025 at a reimbursement rate of $19,703 per course - a significant development. This is a dedicated reimbursement code separate from standard TMS billing, reflecting the distinct protocol. Commercial insurance coverage is evolving. Some plans are beginning to cover SAINT under their existing TMS benefit, particularly when standard TMS criteria are met. Coverage decisions are being made on a plan-by-plan basis and are expected to expand through 2026 as clinical evidence accumulates. The reimbursement landscape makes this a financially viable option at a growing number of academic medical centers and specialized TMS clinics. **Where to Get SAINT TMS** SAINT TMS requires specialized equipment and trained providers. It is currently available at: - Academic medical centers with TMS programs (Stanford, Harvard/McLean, Columbia, Yale, UCSF, and others) - Specialized TMS clinics that have invested in the required equipment and training - The number of providers is growing rapidly following Medicare coverage **Starting the Process** A board-certified psychiatrist needs to document your treatment-resistant depression diagnosis and prior treatment failures before SAINT TMS can be authorized - both clinically and for insurance purposes. This evaluation can be done via telehealth. If you have depression that hasn't responded adequately to medication, SAINT TMS is worth a conversation with a psychiatrist who understands the full range of treatment options available in 2026. The landscape has changed significantly, and options that didn't exist or weren't accessible a few years ago are now covered by Medicare and increasingly by commercial insurance.