The Sanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol is a strictly defined method for conducting transcranial magnetic stimulation, or TMS, at an accelerated rate. TMS is an FDA-approved treatment for depression that is effective, safe, and tolerable. Studies and clinic observation show that over 50% of patients have a meaningful response to TMS and as many as one-third experience complete remission. As current antidepressant medication options are generally unreliable, promote dependency, and come with a variety of unpleasant side effects, additional treatment options for individuals with depression need to be explored further.
TMS treatment typically is administered over the course of 6 weeks with only 5 sessions per week to reach the full 30 sessions. With SAINT accelerated TMS, the entire TMS treatment course can be completed in 5 consecutive days. Evidence is showing that this method of accelerated TMS not only shortens the length of the treatment course, but provides more effective results for patients. The preliminary study conducted by Cole et. al in 2020 displays promising results for the SAINT protocol as a safe and effective method of administering TMS to treat depression — more specifically, treatment-resistant depression.
Participants and Methods
Researchers measured efficacy and assessed safety and tolerability of the accelerated high-dose iTBS protocol using fcMRI-guided targeting. The purpose of the study was to expand on previous studies using a more generalizable cohort. Participants were all required to be experiencing a non-psychotic major depressive episode, whether it be a part of bipolar II disorder or major depressive disorder as defined by the DSM-5. They also were required to have tried at least one antidepressant medication with no response. Six participants had a history of non-response to traditional rTMS treatment. Twenty-three participants were recruited in total, 13 female and 10 male, ages 19-78. Two participants were screened out or dropped out before completion of the study, so 21 total participants were included in the results.
Each participant received structural MRI and resting-state functional MRI scans before the TMS course. The fMRI scans were analyzed for generation of accurate and individualized left dorsolateral prefrontal cortex TMS targets. Depressive symptoms and suicidal ideation were measured using self-report and clinical assessments before and after SAINT. Depressive symptoms were measured at the end of each day’s 10 stimulation sessions using the 6-item HAM-D assessment. The MADRS scale was used at baseline and at follow-up points each week for 5 weeks. A neurophsychological test battery was also administered before and after to measure any neurocognitive side effects.
Researchers administered intermittent theta-burst stimulation, or iTBS, using a MagVenture MagPro X100 system. They delivered 60 cycles of 10 bursts of 3 pulses at 50 Hz in 2-second trains with an 8-second intertrain interval. Ten stimulation sessions were administered per day with 50-minute break intervals. Stimulation was administered for five consecutive days at 90% resting motor threshold.
Results That Last
Bespoke Treatment focuses on non-medication treatments that last. We are the first boutique center in Southern California to specialize in personalised TMS therapy, Ketamine treatment, and neurofeedback. We accept most insurance plans and our administrative team makes the claim process easy. We guide new patients through every step of the process and help obtain any prior authorization on your behalf.
Discussion
The results show that the SAINT accelerated TMS protocol is a safe and extremely well-tolerated treatment for individuals experiencing depression. SAINT significantly reduced depression symptoms and suicidal ideation within 5 days among patients with treatment-resistant depression. Additionally, remission rates observed were higher than previously reported open-label remission rates for FDA-approved rTMS protocols. This suggests that the efficacy of traditional rTMS methods can be improved with SAINT accelerated protocols. These results are meaningful by showing that current TMS treatment can be made more efficient for all patients and more effective, especially for individuals who would not respond to standard rTMS methods. My experience with TMS has been totally life changing. I highly recommend it for anyone experiencing depression and anxiety. It’s not another band aid, it’s a true solution! ~ Amanda K. was introduced to TMS through Bespoke Treatment and it has been a positive experience from the outset. After not responding to antidepressants for nearly a decade, I saw results from TMS after 2 weeks. The staff here are exceptional and I felt comfortable and informed throughout the progression of treatment. I highly recommend both TMS and this office for anyone struggling to address their depression. ~ Audrey K.” I have suffered from severe depression, bipolar disorder and anxiety for over 20 years. I’ve tried every medication on the market, none of which had any positive impact on my symptoms due to my extreme resistance to psychiatric medications. I saw no symptom improvement in addition to suffering from the side effects that came with increasing the amount of medication I was taking. The depression and anxiety greatly interfered with every aspect of my life. It defined who I was. After only 3 weeks into my TMS treatment, I feel better than I have in years. I’ve started feeling joy and motivation and have stopped isolating myself from my friends and loved ones. I’m able to fall asleep naturally and sleep soundly all night without sleep medication. I have my life back thanks to Ben and his team. ~ Li B. I’ve been dealing with depression and anxiety since I was 14 or so. I have tried several medications in the past but have been very reluctant on taking psych meds for the rest of my life. I started looking up depression treatment alternatives being that my symptoms were becoming unbearable (didn’t want to live) and stumbled across your business on google. I couldn’t have found a better place. My life has changed drastically for the better. I wake up hopeful and I actually have a chance at life again. Spravato was instant relief and TMS was just icing on the cake. ~ Nick B.
