Accelerated TMS

STATE STREET TMS uses MagVenture technology.

The Accelerated TMS Treatment for major depressive disorder (MDD) was initially developed by Dr. Nolan Williams and colleagues at Stanford University and is called The Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol. Initial studies demonstrate that the SAINT protocol can produce remarkable results, with approximately 90% remission rates after just one week of treatment. 

 The FDA cleared the SAINT protocol for MDD in September 2022 utilizing the Magnus Neuromodulation System.

 The SAINT Protocol for MDD:

  • utilizes intermittent theta-burst stimulation (iTBS)

  • treating patients with multiple TMS sessions per day at optimally spaced intervals (10 sessions per day over 5 days separated by 50-min intervals – total of 50 treatments)

  • 1,800 pulses per session delivered to individualized functional connectivity-guided targets

  • utilizing a higher overall pulse dose of stimulation

  • Functional MRI (fMRI) to target the region of the left DLPFC

 The specific branded SAINT protocol is restricted to fewer than 10 specialized academic and research centers; however, many independent clinics offer the non- SAINT accelerated protocol for MDD which still utilizes the expedited, intermittent theta-burst stimulation (iTBS) with approved devices (e.g. NeuroStar, BrainsWay, or MagVenture devices).

In our clinic at State Street TMS, we utilize MagVenture technology which is some of the most advanced technology available for Accelerated TMS. (Of note, MagVenture partners with Magnus Medical to provide the technology utilized in the SAINT protocol https://magventure.com/us/magventure-announces-collaboration-with-magnus-medical/)

 The Accelerated TMS protocol for MDD at State Street TMS is built on the foundational SAINT research; however, our protocol utilizes established evidence-based targeting methodology to provide the most effective treatment for depression that we can offer.

 The Accelerated Protocol for MDD at State Street TMS:

  • Treatment Duration: 6 – 10 days - Typically, treatment is started on a Friday, there is a short break over the weekend, and then treatment is completed the following Monday-Friday; this course can be extended up to 10 days to accommodate a patient’s schedule if needed  

  • Technology: MagVenture TMS delivery technology with a figure-8 coil combined with MagVenture Atlas Neuronavigation for precision targeting https://magventure.com/us/products/atlas-neuro-navigation-product-page/

  • Sessions per Day: 5-9 sessions daily (can vary with length of treatment course), each session length is approximately 9 minutes

  • Session Spacing: 50-minute intervals between sessions - optimized spacing intervals to enhance neuroplastic changes associated with effective treatment for MDD

  • Stimulation Parameters: 1,800 pulses of iTBS delivered to the left dorsolateral prefrontal cortex (LDLPFC)

  • Target Location: Left DLPFC using MNI (Montreal Neurological Institute) standard coordinates with an option (depending on protocol) to use your own MRI*

  • Total Sessions: 50

  • Symptom Improvement: occurs more rapidly over the course of 6 – 10 days with marked improvement often occurring by day three of treatment.  At State Street TMS Our clinic's response and remission rates are consistent with the research data, which demonstrates 60-90% symptoms improvement.

*Structural MRI vs MNI Coordinates

At State Street TMS we have administered the Accelerated TMS Protocol for MDD in our clinic using both the MNI coordinates and individual patient structural MRIs; to date we have not seen a significant difference in outcomes using individual structural MRIs vs the MNI coordinates, however, obtaining an individual MRI is an option. The MagVenture Atlas has the ability to utilize both structural and functional MRIs (fMRIs), we don’t commonly use fMRIs as this imaging is often time-consuming, costly and not easily accessible, especially in Vermont. If you would prefer to use your own structural MRI or fMRI, this is something that would be obtained by you through an outside facility. We have used Open MRI in South Burlington in the past for structural MRIs (they do not offer fMRI). We would submit the MRI order to the facility of your choosing. The cost of the MRI would be separate from your TMS treatment in our clinic, the billing for the MRI would be handled by the facility rendering the imaging.