Does MRI‑Based Targeting Enhance Outcomes in Accelerated TMS for Depression?

Magnetic Resonance Imaging: The Key to Superior Outcomes in Accelerated

Brandon Bentzley, MD, PhD, explains that SAINT is becoming a cornerstone for treating severe depression. The therapy delivers rapid symptom relief, allowing patients to return to therapy and daily life within days. Personalized brain targeting significantly improves clinical outcomes, and the reach of the treatment is growing, though robust evidence on suicide risk reduction is still emerging. Historically, interventions such as esketamine, TMS, SAINT, and electroconvulsive therapy were reserved for patients who failed standard antidepressants or could not tolerate psychotherapy. Because SAINT produces an almost immediate effect and requires only a few days of treatment, clinicians are now deploying it earlier in the illness course. The goal is to alter the disease trajectory before hospitalization becomes necessary. This proactive approach is still being studied in collaboration with multiple partners.

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Rapid remission places patients in an optimal position to engage in cognitive‑behavioral therapy, behavioral activation, interpersonal repair, and to resume work or school. Dr. Bentzley notes that such engagement is often impossible during an acute depressive crisis. He stresses that the ability to shift a patient from a depressive to a non‑depressive state quickly is the first essential step toward meaningful collaboration. A randomized clinical trial demonstrated that MRI‑based target identification outperformed scalp‑based methods, with an effect size larger than that seen between active and sham TMS. Bentzley argues that delaying individualized targeting for a few weeks of conventional treatment is not viable for patients in acute distress, especially those at suicide risk. While benefits are clear, evidence for reduced suicide rates remains limited.

Suicide‑related behaviors are measured through self‑report; proving a statistically significant drop in deaths requires large population studies that have yet to be conducted for SAINT.

Access to SAINT has expanded beyond research settings

Access to SAINT has expanded beyond research settings. The platform can host other neuromodulation techniques as they develop. Currently, SAINT systems operate in about 13 U. S. states. Insurance coverage is broad, with more than 80 million people protected by Medicare and private plans. Over 1,200 patients have already received treatment, and the number is rising. Many patients have never tried available therapies, indicating that numerous effective options remain untapped. Dr. Bentzley serves as psychiatrist, medical director, and co‑founder 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‑based targeting versus scalp‑based targeting for accelerated transcranial magnetic stimulation in depression: a randomized clinical trial. JAMA Psychiatry . 2026;83(8):807‑817.