Rapid Remission in Treatment-Resistant Depression With Accelerated TMS

Brandon Bentzley, MD, PhD, shared insights on the Stanford accelerated intelligent neuromodulation therapy (SAINT). The treatment uses structural and functional neuroimaging to identify an individualized target in each patient's brain for transcranial magnetic stimulation (TMS). SAINT was cleared by the US Food and Drug Administration (FDA) to treat depression after inadequate response to or intolerance of 1 antidepressant medication.

After the target is generated, patients receive intermittent theta burst stimulation to the left prefrontal cortex. Bentzley said, "The stimulation sessions are 10 minutes at a time and they're on the hour every hour, 10 times a day for 5 days."¹ Most patients entered remission during that period, which made SAINT one of the fastest routes to remission in treatment-resistant depression.²

Conventional TMS requires daily visits 5 days a week for 6 or more weeks, which was logistically infeasible for many patients, particularly those in rural areas or with work, school, or family obligations. Before SAINT, no FDA-cleared or FDA-approved treatment placed most patients in remission within the typical hospitalization timeline for depression and suicidality. A treatment that worked within that timeline was considered one patients could actually access. Because depression was among the largest risk factors for suicide, rapidly resolving a depressive episode was considered the best means of modifying that risk, and time was medicine for acutely struggling patients, according to Bentzley.

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

References

1. Cole EJ, Stimpson KH, Bentzley BS, et al. Stanford accelerated intelligent neuromodulation therapy for treatment-resistant depression. Am J Psychiatry. 2020;177(8):716-726.

2. 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.