# Accelerated TMS Protocols: The SAINT Trial and What Came After

> When a depression treatment normally runs six to nine weeks, can it be compressed into five days without losing its effect? That is the question accelerated Transcranial Magnetic Stimulation (TMS) protocols were built to answer.

_Published: 2026-11-06_

When a depression treatment normally runs six to nine weeks, can it be compressed into five days without losing its effect? That is the question accelerated Transcranial Magnetic Stimulation (TMS) protocols were built to answer. The short answer from the Stanford research program is that a full therapeutic course can be delivered in a single week, and in a small controlled trial that compressed schedule produced high remission rates — though sample sizes remain small and broad replication is still underway. This article reviews the SAINT and SNT trials, the case-series work that preceded them, and how an accelerated course differs in structure (not in total dose) from the standard protocol.
What "accelerated" actually means
A conventional acute TMS course is roughly 36 sessions delivered five days a week over about six to nine weeks, followed by a taper.1 Accelerated protocols do not add stimulation — they rearrange it. The same kind of total pulse dose is delivered across many sessions per day over a compressed span of days rather than one session per weekday over weeks.
Three design choices distinguish the Stanford accelerated protocol from a standard course:

Compressed scheduling. Roughly 10 sessions per day across 5 consecutive days.2
Spacing between sessions. Sessions are separated by an inter-session interval of about 50 minutes, a spacing chosen to favor durable plasticity rather than back-to-back stacking.3
Individualized targeting. Rather than a scalp-measurement rule, the stimulation site within the left dorsolateral prefrontal cortex is selected using each patient's own functional MRI, targeting the prefrontal subregion most anticorrelated with the subgenual anterior cingulate.2

Each session uses intermittent theta-burst stimulation (iTBS) at roughly 1,800 pulses, a higher per-session dose than the ~600-pulse iTBS used in many standard protocols.2
Why intermittent theta-burst makes compression feasible
iTBS is the patterned stimulation that makes the compressed schedule practical. In the THREE-D non-inferiority trial, iTBS produced antidepressant effects approximately equivalent to standard 10 Hz rTMS while taking roughly one-third of the session time.1 Shorter sessions are what allow ten of them to fit into a single clinic day with adequate spacing between each.
The early signal: Williams 2018
The accelerated concept was first reported as a small open case series. Williams and colleagues described high-dose, spaced iTBS delivered over consecutive days to a handful of patients with highly refractory depression, observing rapid and substantial symptom reduction.3 As a tiny uncontrolled series, it could not establish efficacy — but it provided the dosing and spacing rationale that the later trials formalized.
SAINT open-label: Cole 2020
The first formal study of the protocol — then named Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) — was an open-label trial in patients with treatment-resistant depression. After five days of fMRI-guided accelerated iTBS, a large majority of participants met remission criteria, with effects appearing within days rather than weeks.2 Because the study was open-label and uncontrolled, it could not separate the treatment effect from expectancy or natural course; its value was in demonstrating feasibility, tolerability, and a remission signal worth testing rigorously.
SNT double-blind RCT: Cole 2022
The pivotal test was the Stanford Neuromodulation Therapy (SNT) trial — a double-blind, randomized, sham-controlled study of the same accelerated protocol.4 In the active-treatment arm, approximately 79% of participants achieved remission within weeks of treatment, substantially exceeding the sham arm and reaching statistical significance for the primary outcome.4
That remission figure is striking, and it warrants three caveats:

Small sample. The randomized trial enrolled a modest number of participants; the confidence intervals around a ~79% remission rate are correspondingly wide.4
Single-program origin. The protocol was developed and tested at one center with substantial methodological resources, including individualized fMRI targeting that is not yet routine everywhere.
Replication in progress. Independent and multi-site replication, durability beyond the initial weeks, and real-world effectiveness outside a tightly controlled trial remain active research questions.

In other words, the controlled data are encouraging, but a single small RCT is a starting point for clinical adoption, not a settled basis for it.
Regulatory status
In 2022 the FDA cleared the Stanford accelerated iTBS protocol (SAINT/SNT) through the 510(k) pathway.5 As with all TMS systems, this is a 510(k) clearance, not an "approval," and it applies to the device-and-protocol system rather than to TMS as a category. Healing TMS discusses accelerated protocols at the level of the published science; we do not claim a specific commercial device brand here.
How accelerated and standard courses compare
For a referring clinician weighing options, the practical contrasts are:

Timeline. Standard course: ~6–9 weeks of daily weekday sessions. Accelerated: ~5 days.21
Total dose. Comparable cumulative stimulation, redistributed rather than reduced.
Targeting. Standard protocols commonly use anatomical or scalp-based localization; the Stanford accelerated protocol uses individualized functional-connectivity targeting.2
Evidence base. Standard rTMS and iTBS rest on large multi-site trials; the accelerated protocol rests on a small but rigorous controlled trial plus open-label and case-series data.4

The compressed timeline is especially relevant for patients facing acute distress or logistical barriers to six weeks of daily visits — but candidacy, sequencing, and availability are individual clinical decisions, not an automatic upgrade for every patient.
Key takeaways

Accelerated TMS compresses a full therapeutic course into about five days by delivering roughly 10 iTBS sessions per day, not by reducing total dose.2
The Stanford protocol uses individualized fMRI-guided targeting and ~50-minute inter-session spacing.23
The double-blind SNT trial reported ~79% remission in the active arm, a strong but small-sample result requiring replication.4
iTBS achieves antidepressant effects roughly equivalent to 10 Hz rTMS in about a third of the session time, which makes same-day stacking feasible.1
The accelerated iTBS protocol received FDA 510(k) clearance in 2022 — a clearance, not an approval.5

Considering TMS in Orange County
For patients across Anaheim and the surrounding Orange County area weighing options after multiple antidepressant trials, accelerated protocols are one part of a broader, evolving evidence base for treatment-resistant depression. If you would like a clinician's read on whether a standard or accelerated approach fits a particular history, our team can walk through how TMS therapy works and what a course involves. We can also check your coverage before any decision, since most major commercial payers and Medicare evaluate TMS under specific criteria. The aim is a clear, sourced understanding of what the treatment can and cannot offer.
Sources / Further reading

Blumberger DM, Vila-Rodriguez F, Thorpe KE, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018;391(10131):1683-1692. ↩ ↩ ↩ ↩
Cole EJ, Stimpson KH, Bentzley BS, et al. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. American Journal of Psychiatry. 2020;177(8):716-726. ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩
Williams NR, Sudheimer KD, Bentzley BS, et al. High-dose spaced theta-burst TMS as a rapid-acting antidepressant in highly refractory depression. Brain. 2018;141(3):e18. ↩ ↩ ↩
Cole EJ, Phillips AL, Bentzley BS, et al. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. American Journal of Psychiatry. 2022;179(2):132-141. ↩ ↩ ↩ ↩ ↩
U.S. Food and Drug Administration. 510(k) Premarket Notification: SAINT Neuromodulation System, Magnus Medical, Inc. (K220177). 2022. ↩ ↩