The SAINT Trial: Expanding rTMS for Postpartum Depression

Thalia Robakis, MD, PhD, described an ongoing multicenter randomized clinical trial examining the efficacy and tolerability of the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) transcranial magnetic stimulation (TMS) protocol in women with postpartum depression.¹

Robakis provided context on conventional TMS, explaining that it targets the dorsolateral prefrontal cortex—a region implicated in planning, motivation, and executive function that demonstrates reduced activity in depression—and has been approved by the US Food and Drug Administration for many years.² She then distinguished the SAINT protocol from standard TMS on 3 dimensions: delivery is compressed into multiple daily sessions over a single week rather than one session daily over several weeks; targeting is individualized using neuroimaging rather than external anatomical landmarks; and the total pulse count delivered over the course of treatment is substantially higher.

The rationale for studying SAINT specifically in postpartum depression, Robakis explained, rested on 2 pillars. First, the accelerated one-week treatment course was particularly well suited to new mothers, for whom rapid symptom resolution carries outsized importance for infant health and family functioning. Second, the nonpharmacological nature of the intervention addressed a clinically meaningful preference among postpartum women, including those who are breastfeeding, noting that "there are many women who aren't really that interested in medication, especially if they're breastfeeding."

Robakis expressed confidence in the trial's prospects, noting that SAINT had already demonstrated high efficacy in non-postpartum populations: "we have high hopes that the efficacy will be supported and that the tolerability will be good." The 4-site trial is enrolling participants across New York, UMass, UT Austin, and the Medical University of South Carolina.

Dr Robakis is associate professor of psychiatry at the Icahn School of Medicine at Mount Sinai.

See more about the SAINT trials and Mount Sinai’s women’s mental health resources.

References

1. SAINT in postpartum depression (PPD). Mount Sinai. Accessed April 28, 2026. https://www.mountsinai.org/clinical-trials/saint-in-postpartum-depression-ppd

2. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. US Food and Drug Administration. August 17, 2018. Accessed April 28, 2026. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder