My experience with accelerated iTBS TMS "SAINT" treatment
First, a little background. I have experienced depression since I was a child. In my early 30s, I made a million lifestyle changes hoping to address it. I quit drinking alcohol, lost 60 pounds and made regular exercise a part of my life, quit my job to pursue a passion, moved somewhere with more sun, various therapists, then psych meds. I finally told my psychiatrist I was done and was on my way to self-checkout when she suggested TMS. I did a round of deep rTMS in 2022 on the Brainsway machine, traditional timeline of 30 treatments over 6 weeks and then a taper. I was in complete remission from all depressive symptoms for almost 4 years. I recently noticed my symptoms returning, and at the very first suicidal ideation I decided to go for a second round.
Because I am no longer insured, cannot access treatment where I live, and because of the promising results of the SAINT protocol, I decided to do an accelerated treatment. This made sense for me because it was affordable out of pocket ($7000), and could be conpleted in 5 days, minimizing my expenses and time away from work and life.
My treatment was based on SAINT, with the main difference being that instead of their proprietary algorithm choosing the treatm ent site, it was chosen by a neurologist. The way it was described to me was "just like brand name meds vs generic."I had a resting-state fMRI, and the doctor chose targets in both the left and right DLPFC. I've read all the studies I can get my hands on, and had an extensive discussion with the doctor in the clinic. Based on his recommendation and my own reading, I agreed to be treated alternating right and left sides, in the hope of also addressing the anxiety I experience. The goal of bilateral treatment is is increase excitatory response in the L-DPFC (left dorsolateral prefrontal cortex)and inhibitory response in the R-DLPFC. The doctor told me he had chosen areas on the left and right that connected to each other. I know this is not the actual SAINT protocol.
On the first day of treatment, they tested my motor threshold and then we jumped right in. Using the MagStim coil and neuronavigator, I alternated 10 minute,120% motor threshold treatments on the left DLPFC, and 3 minute 100% motor threshold treatments on the right side. I had 1 treatment every hour for 10 hours over 5 days. I had a total of 50 sessions - 25 on each side. My experience with treatment was that it was uncomfortable, but completely tolerable. Some mild headaches, scalp sensitivity, and intense fatigue were the worst of it. The techs were inexperienced and had had no training other than from the techs who came before them. Woke I did not love this, I reassured myself that the machine was doing the work, and I could see on the neuronavigator screen that the coil was placed in accordance with the sites identified by the doctor.
Before treatment, I discontinued Wellbutrin at the physician's request because of increased seziure risk (common practice for accelerated treatment). I tapered quickly and was off of it for 6 weeks before beginning treatment. I experienced no withdrawl or side effects from discontinuation. Over 8 weeks, I also tapered from 20mg Lexapro daily to 2.5 every three days before I arrived to the treatment center. I had no trouble going from 20mg to 5mg, but at 2.5 I started experiencing withdrawal symptoms, and beginning the first day of TMS, I went back to 5mg/day and have stayed at that dose. I also discontinued buspirone with no effect.
As of today, May 12, 2026, I am 11 days out from the conclusion of treatment. To be blunt, I feel like shit. Much worse than I did before going in. I am extremely irritable, feeling angry and like I could explode at any moment, and the suicidal ideation has increased (don't worry, I'm safe and supported). I'm also crying a lot, which is unusual for me. I'm really, really hoping this is just something akin to "the dip" and maybe happens after accelerated treatment instead of during. I did experience "the dip" during my first round, though I'm not sure it's comparable to what I am feeling now because my circumstances are so different. I'm hoping things will improve over the next week or two. After my initial rTMS, I felt much better at the conclusion of treatment, and continued to improve over the next 6 months.
I'm sharing this because I would like to make myself available to anyone who has questions regarding the "SAINT lite" treatments popping up at clinics and also because I could maybe use some reassurance from anyone who has had a similar experience or knows more than me. Maybe I just need time for my brain to catch up? I went into treatment so optimistic because it had already helped me once. But now I'm worried I let some guy mess with my brain and maybe he didn't know what he was doing after all. I will update as time progresses. l am happy to answer questions, and would be even happier to receive positive anecdotes from anyone who has had a similar experience.