Accelerated transcranial magnetic stimulation

Also known as Accelerated TMS, aTMS, SAINT, Stanford Neuromodulation Therapy, Accelerated iTBS

Accelerated transcranial magnetic stimulation (TMS) gives many short sessions over about five days, and some versions target each person's brain network using a brain scan. The FDA cleared one such system, SAINT, in 2022, but most of the evidence comes from small trials and it is not yet clear how long the benefit lasts.

CommercialReported, unverifiedReviewed 21 Oct 2026
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In plain language

Transcranial magnetic stimulation (TMS) uses a coil placed against the scalp to send short magnetic pulses into the brain. The pulses create small electric currents in the outer layer of the brain, and repeated pulses over one area can change how active that area is. For depression, the coil is usually placed over the left dorsolateral prefrontal cortex, a region involved in mood regulation, and standard treatment is given in clinic sessions over several weeks.

Accelerated protocols aim to get a similar benefit in less time. The best-known example is Stanford Neuromodulation Therapy (SAINT), which uses a pattern of short bursts called intermittent theta-burst stimulation, takes only a few minutes per session, and is given many times a day over five days. In the study reported by Cole and colleagues in 2020, participants had 50 sessions over five days, with the target area chosen from each person's brain scan. The evidence is early and still limited: the randomised trials so far have enrolled few people, and it is not yet clear whether the approach works better than standard treatment or how long any benefit lasts.

Technical explanation

Standard repetitive TMS (rTMS) for depression usually delivers high-frequency pulses, often at 10 Hz, to the left dorsolateral prefrontal cortex, typically on five days a week for four to six weeks. Intermittent theta-burst stimulation (iTBS) uses a patterned burst protocol that takes about 3 minutes per session, compared with about 37.5 minutes for a standard 10 Hz session. In the THREE-D trial, 414 adults with treatment-resistant depression were randomised to 10 Hz rTMS (205) or iTBS (209). The non-inferiority margin was 2.25 points on the HRSD-17, and iTBS was non-inferior on change in HRSD-17 score in a per-protocol analysis. HRSD-17 scores fell from about 23.5 to about 13.4 in the 10 Hz arm and from about 23.6 to about 13.4 in the iTBS arm (Blumberger and colleagues, 2018). The THREE-D report focuses on symptom change rather than remission in its abstract, so it does not by itself show how many people reached remission.

Stanford Neuromodulation Therapy (SNT, also called SAINT) combines iTBS with targeting guided by resting-state functional MRI. In an open-label study, 19 of 21 analysed participants (90.5%) met remission criteria after 50 sessions over five days (Cole and colleagues, 2020). A double-blind, sham-controlled trial (Cole and colleagues, 2022) reported a mean MADRS reduction of 52.5% at four weeks in 14 active-treatment participants, compared with 11.1% in 15 sham participants. A later double-blind, sham-controlled trial of 48 randomised participants at a single site reported remission at one month of 50.0% with active SNT and 20.8% with sham (Kratter, Austelle, Lissemore and colleagues, 2026). The FDA cleared the Magnus Neuromodulation System with SAINT Technology under 510(k) K220177 on 1 September 2022. That clearance does not show that every accelerated protocol is more effective than standard care.

What the evidence says

Each statement is typed by the strength of its evidence and linked to the source that supports it.

Demonstrated Shown in a published experiment, test or shipping product.

In the THREE-D trial, 414 adults with treatment-resistant depression were randomised to iTBS or 10 Hz rTMS, and iTBS was non-inferior on change in HRSD-17 score (adjusted difference 0.103, lower 95% confidence limit -1.16, against a margin of 2.25 points) in a per-protocol analysis.

Sources: [4] · Abstract, Findings and Methods

An iTBS session takes about 3 minutes, compared with about 37.5 minutes for a standard 10 Hz rTMS session.

Sources: [4] · Abstract, Background

In a double-blind, sham-controlled trial of 29 participants (14 active, 15 sham), the mean MADRS reduction at four weeks was 52.5% with SNT and 11.1% with sham, and the authors say further trials are needed to assess durability.

Sources: [2] · Abstract, Results and Conclusions · medium confidence

In a double-blind, sham-controlled single-site trial of 48 randomised participants, remission at one month (MADRS of 10 or lower) was 50.0% with active SNT and 20.8% with sham (p = 0.035), and no serious adverse events occurred.

Sources: [3] · Results, primary outcome and safety · medium confidence

In a 12-month assessor-blinded trial of 281 people who had reached remission, relapse or recurrence was 24.2% with clustered rTMS alone, 15.9% with clustered rTMS plus antidepressants, and 44.4% with antidepressants alone (hazard ratios 0.466 and 0.297 against antidepressants).

Sources: [5] · Abstract, Results · medium confidence

A 2024 meta-analysis of 14 studies, of which only 4 were randomised trials, found no statistically significant short-term difference between accelerated and standard TMS (standardised mean difference -0.67, 95% confidence interval -1.62 to 0.27), with high heterogeneity.

Sources: [6] · Results, Study characteristics and pooled effects

The Magnus Neuromodulation System with SAINT Technology (model 1001K) received FDA 510(k) substantial equivalence under number K220177, with a decision date of 1 September 2022.

Sources: [7] · Device record

Reported, unverified Stated by a company or team but not independently confirmed.

In an open-label study, 19 of 21 analysed participants (90.5%) met remission criteria after 50 accelerated iTBS sessions over five days with resting-state fMRI-guided targeting; 19 of 22 (86.4%) did so on an intention-to-treat basis. The authors state that double-blind sham-controlled trials are needed to confirm this.

Sources: [1] · Abstract, Methods and Results · medium confidence

Proposed A design or plan that has not yet been built or tested.

The THREE-D authors propose that the number of patients treated per day with current rTMS devices could be increased several times without compromising clinical effectiveness.

Sources: [4] · Abstract, Interpretation · medium confidence

Limitations and open problems

  • Most accelerated-protocol evidence comes from small studies: an open-label study of 22 people (Cole and colleagues, 2020), a double-blind trial of 29 people with reported mean MADRS change at four weeks (Cole and colleagues, 2022), and a single-site trial of 48 people (Kratter and colleagues, 2026).
  • Durability beyond about one month is largely untested for SAINT. The 2026 trial did not assess durability beyond one month, and the 2022 authors called for trials of durability.
  • Accelerated and standard TMS have not been compared in large, sham-controlled trials. In a 2024 meta-analysis, the short-term difference between them was not statistically significant, and heterogeneity was very high (I-squared 93%).
  • Individual targeting with resting-state fMRI needs a brain scan and processing before treatment. The sources reviewed did not give verified figures for cost, waiting times or insurance coverage, so access limits are not quantified here.
  • Participant groups were narrow in the 2026 trial: it ran at one site, and participants were mostly highly educated, White or Asian and non-Hispanic.
  • Outcomes are reported in different ways. The THREE-D abstract reports change in HRSD-17 score rather than remission, and remission cut-offs differ between studies.

Possible future uses

Speculative

Ideas, not predictions. None of these has been demonstrated.

  • Shorter accelerated courses in hospital or emergency settings, where a five-day course may suit patients better than a six-week schedule.
  • Pairing individual brain-network targeting with EEG or imaging markers to predict which patients are likely to respond, an idea the 2026 trial's EEG work explores but does not establish.
  • Testing accelerated protocols in other psychiatric conditions, such as bipolar depression. None of the sources reviewed here tested this.

Timeline

  1. 2017Wang and colleagues report a 12-month randomised trial of clustered rTMS for preventing depressive relapse in people who had reached remission. Sources: [5]
  2. Apr 2018The THREE-D trial in The Lancet reports that iTBS is non-inferior to 10 Hz rTMS for depression, with much shorter sessions. Sources: [4]
  3. Apr 2020Cole and colleagues publish online the open-label SAINT study: 19 of 21 analysed participants meet remission criteria after five days of treatment. Sources: [1]
  4. Oct 2021A double-blind, sham-controlled Stanford Neuromodulation Therapy trial is published online in the American Journal of Psychiatry, with 29 participants. Sources: [2]
  5. 1 Sept 2022The FDA clears the Magnus Neuromodulation System with SAINT Technology (510(k) K220177). Sources: [7]
  6. 14 Jan 2026A double-blind, sham-controlled trial of 48 randomised participants is published in World Psychiatry, reporting remission at one month of 50.0% with active SNT and 20.8% with sham. Sources: [3]

Futures this could help bring about

AI illustration
How far away?

Treating severe depression in days with brain stimulation

Pilots · 7 of 9 steps done

Glossary

Transcranial magnetic stimulation (TMS)
A treatment that uses a magnetic coil on the scalp to create small electric currents in the brain.
Intermittent theta-burst stimulation (iTBS)
A TMS pattern made of short bursts of pulses that takes about 3 minutes per session.
MADRS
The Montgomery-Åsberg Depression Rating Scale, a clinician-rated score for depression severity.
Non-inferiority trial
A trial that tests whether a new treatment is not worse than an existing one by more than a set margin.
Sham stimulation
A fake treatment that looks real but does not deliver active stimulation, used as a control.

Sources

  1. peer reviewed paper
    Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression
    Cole EJ et al.. American Journal of Psychiatry, 7 Apr 2020. DOI: 10.1176/appi.ajp.2019.19070720. Accessed 21 Oct 2026.
  2. peer reviewed paper
    Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial
    Cole EJ et al.. American Journal of Psychiatry, 29 Oct 2021. DOI: 10.1176/appi.ajp.2021.20101429. Accessed 21 Oct 2026.
  3. peer reviewed paper
    Stanford neuromodulation therapy for treatment-resistant depression: a randomized controlled trial confirming efficacy, and an EEG study providing insight into mechanism of action and a potentially predictive biomarker of efficacy
    Kratter IH, Austelle CW, Lissemore JI et al.. World Psychiatry, 14 Jan 2026. DOI: 10.1002/wps.70032. Accessed 21 Oct 2026.
  4. peer reviewed paper
    Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial
    Blumberger DM et al.. The Lancet, Apr 2018. DOI: 10.1016/S0140-6736(18)30295-2. Accessed 21 Oct 2026.
  5. peer reviewed paper
    Clustered repetitive transcranial magnetic stimulation for the prevention of depressive relapse/recurrence: a randomized controlled trial
    Wang HN et al.. Translational Psychiatry, 18 Dec 2017. DOI: 10.1038/s41398-017-0001-x. Accessed 21 Oct 2026.
  6. review article
    Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis
    Shi R et al.. BMC Psychiatry, 7 Feb 2024. DOI: 10.1186/s12888-024-05545-1. Accessed 21 Oct 2026.
  7. other
    510(k) K220177: Magnus Neuromodulation System (MNS) with SAINT Technology, Model 1001K
    U.S. Food and Drug Administration, 1 Sept 2022. Accessed 21 Oct 2026.

Revision history

3 changes since this profile was created.

Changes on 21 Oct 2026
Published on owner instruction (content loop iteration 14)00c7ce7
Sources and claims re-checked against originalsfbb434c
Initial profile drafted from primary sources7e66249