Depression is a common condition that affects nearly 1 in 3 adults in America. Since the COVID-19 pandemic depression rates among US adults have nearly tripled.
Additionally, about ⅓ of patients with Major Depressive Disorder (MDD) has been diagnosed with treatment-resistant depression (TRD). Treatment-resistant depression is defined as failed attempts with two or more antidepressant medications.
Transcranial Magnetic Stimulation (TMS) is an FDA-approved therapy for individuals who are struggling with TRD. TMS therapy typically requires 25-30 sessions, 5 days a week, for 4-6 weeks. Each session takes up to 40 minutes and magnetic pulses are delivered to specific areas of the brain.
Scientists were trying to find a faster solution for TRD patients and developed the Stanford Accelerated Intelligent Neuromodulation Therapy protocol (SAINT). SAINT is a type of TMS therapy that works much faster than the currently FDA-approved protocol.
SAINT For Depression
Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) was first developed during the Stanford study that over twenty people volunteered to participate in. All of the participants fit the criteria for severe depression that was treatment-resistant (TRD). TRD can be diagnosed if an individual tries at least two antidepressant medications with no results.
Scientists first used a standard MRI and resting-stating functional MRI (fMRI) on all participants to find out which parts of the brain they should target for each participant. After imaging, they used a specific type of Transcranial Magnetic Stimulation (TMS) therapy called intermittent theta-burst stimulation (iTBS).
Intermittent Theta Burst Stimulation
Intermittent Theta burst stimulation (iTBS) takes much less time than conventional TMS treatment. The theta burst process typically lasts for a total of three to four minutes opposed to traditional TMS which can take up to 40 minutes. iTBS delivers short, powerful bursts of magnetic frequencies to specific areas of the brain.
In Major Depressive Disorder (MDD), certain areas of the brain are not active enough. Based on the fMRI of each participant, iTBS targets the left dorsolateral prefrontal cortex (DLPFC) to the subgenual anterior cingulate cortex (sgACC) circuit which are areas of the brain that are less active in people with MDD. Theta burst can help stimulate these areas to make your neurons more active.
The traditional FDA-approved protocol for iTBS is 600 pulses per day for up to 6 weeks. In the SAINT study, scientists used iTBS treatment for only five days delivering 1,800 pulses per day over ten sessions. Each day, participants had ten sessions that were each ten minutes long with fifty-minute breaks.
SAINT Study Results
The scientists in this study found that 90% of participants went into remission from MDD after the 5 days of iTBS. Scientists also found that one month after treatment, 60% of participants were still in remission from MDD.
No serious, adverse side effects occurred in participants of this study. Participants experienced fatigue and mild discomfort at the stimulation site and in the facial muscles during stimulation.
Using imaging technology, researchers targeted a precise brain region for each specific participant based on the MRI and fMRI. Targeting the region in the brain based on the fMRI may be part of the reason that the SAINT protocol had great efficacy in this study. They then delivered rapid and powerful bursts to this targeted area.
Participants reported feeling relief from symptoms of depression after as little as one day.
Most participants experienced relief within three days of iTBS with the SAINT protocol.
The SAINT study results show that more powerful bursts and the use of fMRI may be a more effective and faster treatment for people who are suffering from treatment-resistant depression.
Benefits of SAINT for Depression Treatment
Individuals who have severe depression can experience suicidal ideation or ongoing thoughts of suicide. This severe symptom requires immediate support and rapid treatment. Antidepressant medication can take six weeks to start feeling the effects, but individuals with suicidal ideation need treatment right away.
The SAINT study scientists tested their participants using three tests for suicidality. The three tests used were the suicidal ideation subscale of the Columbia-Suicide Severity Rating Scale (C-SSRS), item 3 of the 17-item Hamilton Depression Rating Scale (HAM-D), and item 10 of the Montgomery-Åsberg Depression Rating Scale (MADRS).
The Stanford scientists behind SAINT believe that their new protocol for iTBS could keep suicidal individuals safe. This new protocol only involves a few days of treatment and individuals may start seeing results in as little as one day. SAINT has also been proven to be a safe method of treatment with minimal to no side effects.
SAINT Efficacy for TRD
Past treatments like electroconvulsive therapy (ECT) and ketamine have not been as successful as SAINT. ECT reportedly has 48% efficacy in treating individuals with TRD while ketamine treatments have only 31% efficacy.
rTMS therapy, the FDA-approved treatment for TRD, has individuals participating in TMS sessions for four to six weeks. Although this may be an effective option for patients, some individuals may be in need of immediate relief. SAINT may be a better option for people in need of immediate relief of their depression symptoms because the treatments last for only a few days and individuals can start seeing results in as little as one day.
Another advantage of SAINT is that it targets a specific brain region known to have low activity in people with MDD by using an fMRI before treatment. This can make your therapy even more targeted and even more effective.
The scientists behind SAINT are working on a new trial now. The first trial they conducted did not include a placebo group meaning that all participants received the same treatment. Scientists are currently working on other studies involving the SAINT protocol with iTBS.
Current studies include:
- Accelerated iTBS for Depression and Suicidality (RAPID) – not yet recruiting; estimated study completion date July 2024
- SAINT for Treatment of Preoperative Depression to Reduce Opioid Use Following Arthroplasty, iTBS Study for Depression (Randomized) – not yet recruiting; estimated study completion date November 2023
- The Effects of Stanford Accelerated Intelligent Neuromodulation Therapy on Explicit and Implicit Suicidal Cognition – not yet recruiting; estimated study completion date September 2025
- Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression: OL Cohort (SAINT-TRD) – this study has been completed, the results were submitted January 26, 2022, but have not yet been posted.
Traditional depression treatments often take time to start working, but people with severe MDD may not have time to waste. Some individuals who take antidepressant medications do not see improvement for months while others may not respond to antidepressant medications at all.
TMS for Individuals with TRD
Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) can be the future of TMS therapy and produced great efficacy among TRD participants in its most recent study. At Clear Care Center in Orange County, CA, we utilize TMS therapy to help patients overcome their treatment-resistant depression.
If you or a loved one are struggling with depression and antidepressants have given you no relief, it may be time to try TMS therapy. Contact us today to answer any questions you may have and get a better understanding of our program.