Major depression is one of the most common forms of mental illness in the U.S. More than 8% of all adults in the U.S. had at least one depressive episode in the past year, according to data from the National Institute of Mental Health.
A relatively new treatment option could make it possible to reduce depression in this population, particularly among people who have not responded well to other treatment methods: Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT®).
SAINT is a noninvasive method that uses magnetic pulses to stimulate targeted areas of the brain. The therapy has been commercially available since 2022, and the results from patients who have received this therapy option are encouraging.
"We have so many different treatment options that are now available to patients for depression," said Nicholas Trapp, MD, a psychiatrist with University of Iowa Health Care. "Most people classically think of antidepressant medications. Psychotherapy is another standard option. And now, we have this whole new realm of neuromodulation therapies—a fancy term for brain stimulation."
University of Iowa Health Care is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Trapp talked about SAINT and its benefits for physicians in a recent episode of “AMA Update.” Here is what physicians should know.
A “rapid acting” form of TMS
SAINT is a form of transcranial magnetic stimulation (TMS), a noninvasive brain stimulation technology that has existed since the 1980s and has been used therapeutically since 2008, Dr. Trapp said. Standard TMS features a pair of electric coils that are placed against a patient's head.
"That coil, when you pass electricity through, it will generate a magnetic field, and the brain can translate that magnetic field back into electrical energy," said Dr. Trapp, assistant professor of psychiatry at the University of Iowa. "This can be used to depolarize neurons and, very basically, activate or inactivate different areas of the brain."
With traditional TMS, patients receive treatments five days a week over the course of multiple weeks—sometimes up to six weeks, according to Dr. Trapp. One of the big differentiators of SAINT is that it truncates the timeline for treatment.
Instead of six weeks of treatment, patients can receive their full treatment allotment in just five days.
"SAINT is a very rapid-acting, high-dose form of transcranial magnetic stimulation," Dr. Trapp said.
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A form of precision medicine
SAINT does more than just speed up the treatment timeline. It also provides the opportunity to deliver precision medicine—also called "personalized medicine”—to patients.
Prior to undergoing SAINT, patients receive a functional MRI that looks at changes in blood oxygen levels in different regions of the brain. The patient's care team can then use that information to identify how and where SAINT can be most effectively targeted.
"It does that by generating a connectivity target in the prefrontal cortex of the brain to try to modulate deeper brain regions that we know are involved in depression," Dr. Trapp said.
Dr. Trapp is well versed with SAINT. Prior to his current role at the University of Iowa, Dr. Trapp did a fellowship in neuropsychiatry and behavioral neurology at Stanford. There, he worked in the lab of Nolan Williams, whose lab developed the technology for SAINT.
"We got involved in some research while I was there, and I was able to see some patients who had pretty impressive treatment responses," he said. "Then we got involved offering this at Iowa commercially and being involved in some clinical trials around the use of SAINT."
A reduction in treatment time
SAINT has only been available at the University of Iowa for a few months. While he does not have statistics to share yet about the therapy's effectiveness at his facility, external data points show reason for optimism.
Standard TMS treatments can improve symptoms in about 50–60% of patients, and over 30% achieve remission. But a key trial conducted with SAINT found that during the one-month period after treatment, 79% of patients achieved remission.
"Until recently, it was rare to have a treatment that could get patients better within a five-day period of time," Dr. Trapp said. "What we've seen so far is, when patients do well, they seem to do very well, and they respond very quickly."
Similar SAINT-like protocols are currently being examined for obsessive compulsive disorder and bipolar disorder, he said.
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