Accelerated TMS and SAINT: How Five-Day TMS Works

Standard TMS asks for about six weeks of daily weekday visits. Accelerated TMS compresses that into days by delivering several sessions per day — and the best-known version, SAINT, has produced some of the most striking results in depression research. It's also expensive, hard to access, and newer than standard TMS. Here's what accelerated TMS and SAINT actually involve, and who they make sense for.

The short version

• Accelerated TMS delivers multiple TMS sessions per day, shrinking a weeks-long course into about one week.
• SAINT (also called Stanford neuromodulation therapy, or SNT) uses 10 short theta-burst sessions a day for five days, aimed at a target personalized with MRI brain scans.
• FDA clearance: SAINT was cleared in September 2022 for adults with major depression who haven't improved enough on prior antidepressants in the current episode.
• Evidence: promising but based on small trials; durability is still being studied.
• Cost and access: the few published self-pay prices run roughly $30,000+, private insurers generally don't cover it, and only a limited number of sites offer it.

What "accelerated" means

Standard TMS delivers one session a day, five days a week, for about six weeks. Researchers found that theta-burst stimulation — rapid bursts of pulses — could deliver an effective dose in about 3 minutes rather than 20–40, which made it practical to give several sessions per day with breaks in between.

There are now several accelerated approaches:

• SAINT/SNT, the Stanford protocol described below.
• Accelerated deep TMS. In September 2025, the FDA cleared an accelerated protocol for BrainsWay's deep TMS, with an acute phase of six treatment days instead of four weeks of daily sessions, followed by maintenance. Its trial found symptom reduction similar to the standard deep TMS protocol.
• Clinic-designed accelerated schedules using standard equipment — for example, two or more sessions a day. These vary widely and are less standardized.

How SAINT works

SAINT differs from standard TMS in three ways:

1. Personalized targeting. Before treatment, you have structural and functional MRI scans. Software identifies the spot in the left prefrontal cortex that's most strongly anticorrelated with the subgenual cingulate, a region linked to depression — and that individual spot becomes your target.
2. High dose. Each session delivers 1,800 pulses of theta-burst stimulation — more than standard theta-burst.
3. Compressed schedule. Ten 10-minute sessions per day, spaced about 50 minutes apart, for five consecutive days — 50 sessions in total.

In practice, that means spending most of a working day at the clinic for a week. You're awake throughout and can read, watch TV, or rest between sessions.

The evidence so far

• Open-label study (2020): In Stanford's initial study of 21 people with treatment-resistant depression, 19 of 21 (about 90%) met remission criteria right after treatment. Without a placebo group, though, this can't separate the treatment's effect from expectation.
• Randomized controlled trial (2022): A double-blind, sham-controlled trial published in the American Journal of Psychiatry reported remission in about 79% of active-treatment participants vs. about 13% with sham, measured four weeks after treatment. It was small — 29 participants in the analysis.
• Replication trial (2026): A larger, sham-controlled trial published in World Psychiatry randomized 48 participants and found 50% remission with active treatment vs. about 21% with sham at one month. The effect was smaller than in the earlier trial but still clearly favored SAINT.

The honest summary: SAINT has strong early results and real replication, but the trials are small, and questions remain about how long remission lasts and how well results generalize outside research centers. Side effects reported in trials have been similar to standard TMS — mainly fatigue and headache. See TMS side effects for the full picture, including seizure risk.

Cost and insurance

SAINT is expensive. Few clinics publish prices; the self-pay quotes we found run roughly $30,000–$36,000 for the five-day course, reflecting the MRI scans, targeting software, and a full week of clinic time. That's several times the cost of a standard course — see how much TMS costs for comparison.

Insurance coverage is limited. Most commercial insurers, including Aetna, currently classify SAINT and other accelerated TMS protocols as experimental. Medicare has created payment pathways for SAINT in hospital inpatient and outpatient settings, which has opened access for some Medicare patients at participating hospitals. If you're considering SAINT, ask both the clinic and your insurer specifically — and get any coverage confirmation in writing. Our TMS insurance guide covers standard TMS coverage.

Availability

SAINT is delivered only at sites licensed by Magnus Medical, the company that commercializes it under license from Stanford. The number of sites has been growing but remains limited, and some have waiting lists. Accelerated deep TMS and clinic-designed accelerated schedules are more widely available because they use equipment many TMS clinics already have.

Who accelerated TMS suits

Accelerated TMS can make sense if you:

• Can't sustain six weeks of daily visits due to work, distance, or caregiving — but can clear one week.
• Need relief faster than standard TMS's gradual timeline.
• Live far from a TMS clinic and could travel for one week rather than commute for six.
• Didn't respond to standard antidepressants and have the means to pay out of pocket, or have Medicare and access to a participating hospital.

It's probably not the first move if standard TMS is covered by your insurance and the schedule is manageable — that path costs a fraction as much and has a much longer track record. And if you need relief in days and can't access SAINT, ketamine or Spravato may be faster and more accessible; see TMS vs. ketamine for the comparison.

Bottom line

Accelerated TMS, and SAINT in particular, is the most exciting development in TMS in years: one week instead of six, with promising remission rates in controlled trials. The trade-offs are real — high cost, limited insurance coverage, few sites, and less long-term data. If you're interested, ask any clinic exactly which protocol they offer (SAINT, accelerated deep TMS, or an in-house schedule), what it costs all-in, and what the plan is if symptoms return. To compare options, find a TMS provider near you, and read what to expect during TMS treatment for how the standard course works.