How SAINT TMS Holds Up in Practice

The late Nolan Williams developed SNT TMS, shown delivering it above

Its large effect in treatment resistant depression holds up in the real world of comorbidities and complexities

STUDY: Feyder MT et al, J Mood Anxiety Disord 2026

STUDY TYPE: Open-label multicenter cohort study

FUNDING: Magnus Medical Inc (manufacturer of SNT)

Background

SNT TMS (previously called SAINT) brought an unprecedented 80% of patients with highly refractory depression to remission within a week, earning it FDA clearance in September 2022. Now comes the first real-word results.

The protocol for SNT in intensive. A brief TMS treatment (using iTBS) is delivered every hour, 10 hours a day, for five days. To enhance precision, the magnet is placed with fMRI guidance.

The Study

• 101 adults with major depressive disorder who had failed at least one antidepressant in the current episode, enrolled across 7 private clinics in the US.
• Depressions were chronic (mean episode duration 3.8 years), but only 2% had prior ECT and 1% had prior psych hospitalization.
• Comorbidities: History of… Anxiety (43%), ADHD (26%), PTSD (5%), Bipolar (2%), Autism (3%), Anorexia (3%), OCD (2%), stroke (2%), TBI (2%).
• No placebo control.

68% of patients were rated “much improved” by day 5, with a mean improvement score (CGI-I) of 2.32 out of 7. By one-week post-treatment, 89% showed meaningful clinical benefit, defined as at least a one-point drop on a severity scale (CGI-S). Symptom scores on the Depression scale (MADRS) fell 41% from baseline (effect size, Cohen’s d = 0.98).

Anxiety, sleep, concentration, and suicidality all improved on individual MADRS items. Patients taking stimulant medications showed about 4 additional points of improvement on the MADRS (consistent with research showing stimulants may enhance TMS response).

No one dropped out due to side effects.

Side Effects

Headache, fatigue, scalp discomfort, dizziness, and transient insomnia were the most common, most resolving the same day. No treatment-emergent mania. No cognitive decline.

Limitations

No sham control. Industry-funded by the device maker. The sample was predominantly White, highly educated, and self-pay, limiting generalizability. Treatment resistance criteria weren’t formally documented.

Practice Implications

1. For treatment resistant depression, consider TMS first, and SNT TMS if it is feasible or the depression is highly refractory, such as failing TMS/ECT or over four antidepressant strategies.
2. Learn how to refer for SNT TMS and find local providers in our Carlat Podcast.