Does MRI-Based Targeting Improve Outcomes With Accelerated TMS for Depression?

Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) can become an essential component of treatment plans for severe depression, shared Brandon Bentzley, MD, PhD. Interventional treatments such as esketamine, transcranial magnetic stimulation (TMS), SAINT, and electroconvulsive therapy typically were considered after inadequate response to or intolerance of antidepressants or psychotherapy. Because SAINT's effects were rapid and the full course required only a few days off rather than weeks, clinicians had begun using it earlier—to change the course of illness before acuity warranted hospitalization.¹ SAINT had been deployed only briefly, so this use remained under study with partner institutions.

Rapid remission, or near remission, positioned patients to engage in cognitive behavioral therapy, behavioral activation, relationship repair, and return to work or school—efforts that Bentzley said could be impossible during severe acute depression. "Having something that can really rapidly and really dramatically change them from being in a depressive state to a nondepressive state becomes that first step to being able to engage with them," Bentzley said.

Personalization also contributes to this success. A randomized trial found that magnetic resonance imaging–based targeting improved outcomes compared with scalp-based targeting, with an effect size larger than that separating sham from active TMS.² Bentzley argued that delaying individualized targeting to trial conventional methods for several weeks was untenable in acutely distressed patients, particularly when suicidality was a potential outcome.

Evidence for suicide reduction remained limited. Changes in suicidality were measurable with surrogate measures, including self-report, but demonstrating fewer suicides required large population-level research that did not yet exist for SAINT.

Access had expanded beyond research settings, and the platform could host additional neuromodulation approaches as they were developed. "Right now, we have SAINT systems across about 13 states. There's Medicare and private insurance coverage of over 80 million people. And we've already treated over 1200 patients, and that's expanding rapidly," Bentzley said. He added that many patients had abandoned or never tried available treatments, and that many effective options remained.

Dr Bentzley is a psychiatrist, chief medical officer and cofounder of Magnus Medical.

References

1. Cole EJ, Phillips AL, Bentzley BS, et al. Stanford neuromodulation therapy (SNT): a double-blind randomized controlled trial. Am J Psychiatry. 2022;179(2):132-141.

2. Taylor JJ, Kare MR, Haj-Darwish D, et al. Connectivity- vs scalp-based targeting of accelerated transcranial magnetic stimulation for depression: a randomized clinical trial. JAMA Psychiatry. 2026;83(8):807-817.