Accelerated TMS (Transcranial Magnetic Stimulation)
Intensive 5-day brain stimulation protocol using magnetic pulses to treat depression and anxiety, compressing months of traditional TMS into one week
Bottom Line
Accelerated TMS, developed by the late Dr. Nolan Williams at Stanford, represents a breakthrough in brain stimulation therapy. Traditional TMS requires daily sessions for 6+ weeks; accelerated TMS compresses this into 5 intensive days.
Tim Ferriss's experience:
- Anxiety dropped from 8-9/10 to near zero
- Effects lasted 3-4 months per treatment
- Describes it as "computer chips over pills"
- Has done multiple rounds
Evidence status:
- FDA-cleared for depression (traditional TMS)
- Stanford SAINT protocol showed 90% remission rates in trials
- Growing adoption at specialized clinics
- Strong mechanistic understanding
Important context:
- Requires clinical setting with trained practitioners
- Not a DIY intervention
- Expensive but potentially life-changing for treatment-resistant cases
- Different from consumer "brain stimulation" devices
One of the most promising developments for treatment-resistant depression and anxiety. If you've tried medications without success and have the resources, this deserves serious consideration.
Science
How TMS Works:
Basic Mechanism:
- Magnetic coil placed against scalp
- Produces brief magnetic pulses
- Induces electrical currents in brain tissue
- Modulates neural activity in targeted regions
Accelerated Protocol Innovation:
- Traditional: 1 session/day for 6 weeks (30+ sessions)
- Accelerated (SAINT): 10 sessions/day for 5 days (50 sessions)
- Same total "dose" compressed in time
- May be more effective due to neuroplasticity principles
Stanford SAINT Protocol:
- Intermittent theta burst stimulation (iTBS)
- 1,800 pulses per session
- 10 sessions per day
- 50-minute intervals between sessions
- Precise targeting using fMRI
- Focus on left dorsolateral prefrontal cortex (DLPFC)
Neurobiological Effects:
Immediate:
- Increased cortical excitability
- Altered blood flow patterns
- Neurotransmitter modulation
Sustained:
- Synaptic plasticity changes
- Network connectivity shifts
- Gene expression changes
- BDNF upregulation
Key Research:
Stanford SAINT Trial (2022):
- 90% response rate
- 79% remission rate
- Effects sustained at 4-week follow-up
- Rapid onset (within days)
Traditional TMS Meta-analyses:
- 50-60% response rates
- 30-40% remission rates
- Effects last months to years for many
Supporting Studies
6 peer-reviewed studies
View all studies & compare research →Practical Protocol
Stanford SAINT Protocol:
| Parameter | Detail |
|---|---|
| Duration | 5 consecutive days |
| Sessions/day | 10 |
| Pulses/session | 1,800 |
| Total pulses | 90,000 |
| Inter-session interval | 50 minutes |
| Targeting | fMRI-guided |
| Location | Left DLPFC |
Daily Schedule Example:
- Session 1: 8:00 AM
- Session 2: 8:50 AM
- ...continue every 50 minutes...
- Session 10: ~3:30 PM
Pre-Treatment:
- Psychiatric evaluation
- fMRI for targeting (at advanced centers)
- Medication review
- Rule out contraindications
During Treatment:
- Seated comfortably
- Magnetic coil positioned on head
- Clicking sounds with each pulse
- May feel tapping sensation
- Fully conscious throughout
Post-Treatment:
- Typically can drive home
- Resume normal activities
- May have mild headache
- Effects often noticed within days
Maintenance:
- Some need repeat treatment every 3-12 months
- Tim Ferriss has done multiple rounds
- Depends on individual response
Finding Treatment:
- Search for "accelerated TMS" or "SAINT protocol" clinics
- Stanford, Magnus Medical clinics
- Specialized psychiatric practices
- Academic medical centers
Risks & Side Effects
Common Side Effects:
- Headache (most common, usually mild)
- Scalp discomfort at treatment site
- Lightheadedness
- Facial twitching during treatment
Rare but Serious:
- Seizure (very rare, <0.1%)
- Mania induction (in bipolar patients)
- Hearing changes (wear ear protection)
Contraindications:
- Absolute:
- Metallic implants in/near head (except dental)
- Cochlear implants
- Implanted stimulators (VNS, DBS)
- Aneurysm clips
- Relative:
- History of seizures or epilepsy
- Severe brain injury
- Brain tumors
- Pregnancy (limited data)
- Bipolar disorder (risk of mania)
Drug Interactions:
- Medications that lower seizure threshold
- Stimulants (may enhance effects)
- Review all medications with provider
What to Expect:
- Loud clicking during treatment
- Possible mild headache after
- Fatigue during treatment week
- Emotional processing during/after
Risk Level: Low when properly administered; requires trained clinicians
Who It's For
Ideal Candidates:
- Treatment-resistant depression (failed 2+ medications)
- Severe anxiety disorders
- Those who can't tolerate medication side effects
- People seeking rapid relief
- Those with resources for treatment cost
May Benefit:
- OCD (specific protocols)
- PTSD (emerging evidence)
- Chronic pain conditions
- Addiction (experimental)
Should Consider Carefully:
- First-line treatment seekers (try standard options first)
- Those with contraindications above
- People expecting permanent "cure" (may need maintenance)
- Anyone uncomfortable with brain stimulation
Not Appropriate For:
- Those with metallic head implants
- Active seizure disorders
- Unstable bipolar disorder
How to Track Results
What to Measure:
- Depression scales (PHQ-9, BDI)
- Anxiety scales (GAD-7)
- Daily mood rating (1-10)
- Sleep quality
- Functional improvement (work, relationships)
Clinical Tracking:
- Clinics typically administer standardized assessments
- Pre, during, post, and follow-up measurements
- Track medication changes
Self-Monitoring:
- Daily mood/anxiety journal
- Note any side effects
- Track sleep quality
- Record significant life events
Timeline:
- Day 1-5: Treatment week, may notice shifts
- Week 2: Effects typically solidifying
- Week 4: Standard follow-up assessment
- Month 3-6: Monitor for sustained benefit
- Consider maintenance if effects fade
Top Products
Treatment Providers:
Stanford-Affiliated:
- Stanford Brain Stimulation Lab - Where protocol developed
- Magnus Medical - Commercializing SAINT protocol
Specialized Clinics:
- Search "accelerated TMS near me"
- Academic medical centers
- Advanced psychiatric practices
Equipment Manufacturers (for reference):
- MagVenture - TMS devices
- Brainsway - Deep TMS systems
- Neuronetics - NeuroStar systems
Finding a Provider:
- Search for accelerated or intensive TMS
- Ask about SAINT protocol specifically
- Verify fMRI targeting capability (gold standard)
- Check provider credentials and experience
- Ask about outcomes data
Questions to Ask:
- How many accelerated TMS patients have you treated?
- What protocol do you use?
- Do you use neuroimaging for targeting?
- What are your response/remission rates?
- What follow-up care is included?
Cost Breakdown
Treatment Costs:
| Treatment Type | Cost Range |
|---|---|
| Accelerated TMS (SAINT-like) | $8,000-15,000 |
| Traditional TMS (6 weeks) | $6,000-12,000 |
| Single maintenance session | $300-500 |
Insurance Coverage:
- Traditional TMS often covered for depression
- Accelerated protocols may be out-of-network
- Prior authorization typically required
- Appeal process possible for denials
Cost Breakdown:
- fMRI targeting (if used): $500-1,500
- Treatment sessions: $5,000-10,000
- Professional fees: $1,000-3,000
- Follow-up visits: $200-400 each
Value Consideration:
- Compare to years of medication costs
- Compare to therapy costs
- Consider quality of life impact
- May reduce other healthcare utilization
Podcasts
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Discussed in Podcasts
54 curated moments from top health podcasts. Click any timestamp to play.
TMS explained as an external pacemaker for feelings
Dr. Muir offers an elegant explanation of TMS as an external pacemaker for emotions, using magnetism to induce electrical currents that resynchronize brain rhythms.
"TMS transcranial, aka going across the cranium into the brain harmlessly, magnetic, using magnetism stimulation, is basically an external pacemaker for your feelings."
Accelerated TMS achieves 79-90% remission rates
Dr. Muir presents the clinical data showing accelerated TMS with the SAINT protocol achieves 79% remission for depression using 10 daily stimulations over five days, a fundamentally different outcome than medication-based approaches.
"That was the approach in that study. Yeah. Without any, any drugs at all. The, the, the saint trial and, and, uh, other, other papers on that topic on accelerated TMS, uh, use 10 stimulations in a day and did it over five days in a row. And we're getting remission in 79% of people at the end of a month. Um, 60, 60% are in remission. Their depression is over at the end of day five. And like,"
Warning about life changes after TMS remission
Dr. Muir discusses the consent challenges unique to TMS, including warning patients that full remission from depression can trigger major life decisions like divorce, because the experience is so fundamentally different from 50% symptom reduction.
"I warn people getting accelerated TMS that we've seen people get a divorce after this treatment. Now, it turns out a lot of people who are depressed and have been depressed for a long time will get better and realize they're not happy with their life."
TMS for OCD achieves 31% remission
Dr. Muir discusses TMS outcomes for OCD, noting a 31% full remission rate and that personality disorders do not predict non-response to treatment.
"We have remission in OCD on the order of 31%, but full remission is less likely than it is in depression."
TMS can treat addiction by targeting brain areas
Transcranial magnetic stimulation non-invasively modulates brain activity in addiction, with strong double-blind evidence.
"But, you know, yeah, it's covered. I think Medicare actually covers it. Whether they cover the specific protocol that Nolan did, I'm honestly not sure, you know, because there was a lower intensity one. And New Orleans, you know, genius was to compress this treatment. So people would come in five days in a row and have 10 minutes on, 50 minutes off, I believe that's the thing, the rate, all day long, five days, and with a theta burst setting for the RTMS. And I've seen some people's lives just absolutely changed by that. And you can see as trial, I mean, it's a trial, it's a good trial, unlike what's like."
Nolan Williams' legacy and the SAINT protocol
Dr. Heacock opens by honoring the late Nolan Williams as a leading light of psychiatry who pioneered the accelerated SAINT protocol for TMS at Stanford.
"Today's episode, I would say, was inspired by the work of Nolan Williams. He was really a leading light of psychiatry, psychiatrist at Stanford, and a pioneer, not just of TMS, transcranial magnetic stimulation, but an accelerated form called SAINT."
How neuro-navigation made SAINT protocol so effective
The discussion identifies fMRI-guided neuro-navigation as the special sauce that made the SAINT protocol dramatically more effective than previous accelerated approaches.
"Nolan Williams, when he did Saint, he put many different things together. So they used shorter protocol in intermittent theta bursts. They combined it with many, many, many treatments a day."
Ketamine and TMS as complementary rather than competing treatments
Dr. Fenstermacher suggests ketamine and TMS serve different roles: ketamine for rapid crisis stabilization, then TMS for producing durable remission, forming a sequential treatment strategy.
"I wonder if maybe we're asking the wrong question. It might be that they actually serve different purposes. Ketamine is the thing that rapidly helps someone who is acutely hopeless, suicidal, and we're using ketamine to pull them out of the hole quickly."
Durability tradeoff between accelerated and standard TMS
Dr. Fenstermacher reveals that accelerated TMS protocols may sacrifice some durability compared to the standard six-week course, which was actually one of the motivations for developing accelerated protocols in the first place.
"I should comment on the durability of the accelerated protocols. That was actually the reason the accelerated protocols were developed was to try to address the fact that so many patients were dropping out."
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Who to Follow
Developers:
- Dr. Nolan Williams (Stanford) - Created SAINT protocol, passed away 2024
- Stanford Brain Stimulation Lab team
Advocates:
- Tim Ferriss - Personal user, multiple rounds, major advocate
- Describes as "computer chips over pills"
- Reports anxiety dropping from 8-9/10 to near zero
- Effects lasted 3-4 months per treatment
Clinical Community:
- Growing adoption among psychiatrists
- Presented at major psychiatric conferences
- Published in major journals (American Journal of Psychiatry)
Synergies & Conflicts
Complementary Approaches:
- Therapy (especially during/after treatment)
- Meditation/mindfulness
- Exercise (enhances neuroplasticity)
- Sleep optimization
Medication Considerations:
- Often can reduce/eliminate medications
- Work with psychiatrist on tapering
- Some maintain low-dose medication
Lifestyle Factors:
- Sleep optimization - Critical for maintaining benefits
- Exercise - Supports neuroplasticity
- Morning sunlight - Circadian health
- Stress management
What NOT to Combine:
- Don't discontinue medications without guidance
- Avoid excessive alcohol during treatment
- Don't expect TMS to replace healthy lifestyle
Post-Treatment Stack:
- Continue therapy if helpful
- Maintain exercise routine
- Sleep hygiene
- Stress management practices
- Monitor and seek maintenance if needed
What People Say
Research:
Notable Users:
User Feedback:
Criticisms: