A standard transcranial magnetic stimulation (TMS) course asks for roughly six weeks of daily visits. For a person who works, parents or lives far from a clinic, that schedule can be the real barrier to treatment, not the treatment itself. This approach exists to remove that barrier. It delivers several sessions in one day so the full dose of stimulation fits into days instead of weeks, and the best-known version, SAINT, does it in five.
This guide explains what accelerated TMS is, how the SAINT protocol works, what the research does and does not show, who is a good candidate, and why insurance coverage has not caught up. It is written for patients considering a faster option and for referring clinicians. For the standard schedule first, see our session-by-session guide to how TMS works. One point up front: Village TMS currently provides standard daily TMS only. We do not offer theta burst, accelerated schedules or SAINT at this time.
| What We Know
Accelerated TMS delivers multiple sessions per day to shorten a course. SAINT, also called Stanford Neuromodulation Therapy, is one specific protocol: 50 theta burst sessions of 1,800 pulses each, given as 10 sessions a day over five days with about 50 minutes between sessions. The FDA cleared a SAINT device on September 1, 2022. In the first double-blind, sham-controlled SAINT trial (29 patients), 57.1 percent reached remission right after treatment compared with 0 percent on sham, and a second double-blind trial reported in 2026, with 48 randomized patients, found one-month remission of 50 percent versus about 21 percent on sham. Follow-up is still short and the studies are small. Many insurers, including Cigna, still classify accelerated protocols as investigational, so a shorter schedule can mean paying out of pocket even when a standard course would be covered. Cigna lists theta burst stimulation itself as investigational, not only fully accelerated schedules. |
What is accelerated TMS?
An accelerated schedule is any TMS plan that delivers more than one session per day, so a course that would normally take four to six weeks is compressed into a few days to a few weeks. The magnetic pulses are the same kind used in standard treatment. What changes is how tightly the sessions are packed.
The National Institute of Mental Health notes that accelerated protocols show similar effectiveness to standard rTMS while shortening treatment, so patients can receive a whole course in much less time and get relief sooner. That is the promise. The caveat is that the evidence behind each specific protocol is newer than the evidence for standard daily TMS.
How is accelerated TMS different from standard TMS?
Standard TMS delivers one session a day, five days a week, for about six weeks. The faster approach delivers several sessions a day over a much shorter period. Many accelerated protocols use theta burst stimulation, a patterned form of TMS that delivers a session in a few minutes rather than 20 to 30.
| Standard TMS | Accelerated TMS | SAINT (Stanford protocol) | |
|---|---|---|---|
| Sessions per day | 1 | 2 to 10, depending on protocol | 10 |
| Course length | About 36 sessions over roughly 6 weeks at Village TMS | Days to a few weeks | 5 consecutive days, 50 sessions |
| Pattern | Standard high-frequency pulses, about 20 to 30 minutes per session | Often theta burst, a few minutes per session | Intermittent theta burst, 1,800 pulses per session |
| Targeting | Motor threshold calibration and scalp measurements | Varies by clinic | MRI-based targeting of a personalized brain site |
| Typical coverage | Commonly covered with prior authorization | Often investigational | Often investigational |
Village TMS currently offers standard daily TMS: one session a day, five days a week, over about six weeks. We do not offer theta burst, accelerated schedules or SAINT at this time. Standard daily TMS is also the protocol with the longest track record and the broadest insurance coverage, which is why most plans build their criteria around it. If you are interested in a faster option, your psychiatrist can explain how it compares with a standard course for your history.
What is the SAINT protocol?
SAINT is an accelerated theta burst protocol developed at Stanford for treatment-resistant depression. It delivers 10 short sessions a day for five days, about 50 minutes apart, for 50 sessions in total and 90,000 pulses. A cleared device using the protocol, with MRI-guided targeting of a personalized site in the left prefrontal cortex, received FDA clearance in September 2022.
Four features distinguish SAINT from a typical accelerated schedule:
- Dose. Each session delivers 1,800 pulses of intermittent theta burst stimulation, far more total stimulation than a standard course delivers in the same time.
- Spacing. About 50 minutes between sessions gives the brain time to respond between doses, which the developers designed to improve effect.
- Personalized targeting. The treatment site is chosen using MRI-based connectivity analysis rather than scalp measurements alone.
- Compression. The full course is delivered over five consecutive days, which means long days at the clinic but no weeks of daily visits.
Do accelerated schedules work as well as standard TMS?
The evidence is promising but early. The first sham-controlled trial of the Stanford protocol, published in the American Journal of Psychiatry in 2022, randomized 29 patients with treatment-resistant depression. Immediately after the five-day course, 57.1 percent of the active group were in remission versus 0 percent of the sham group, and 71.4 percent responded versus 13.3 percent.
A second double-blind, sham-controlled trial in a newly recruited and larger sample, reported in World Psychiatry in 2026, randomized 48 patients. One month after treatment, 50 percent of the active group were in remission versus about 21 percent on sham. Active treatment again came out ahead, but the sham group did far better than in the first trial, a reminder of how much small trials can swing. Earlier open-label work without a sham group reported higher remission, around 90 percent, but open-label results are consistently more optimistic than blinded ones.
Two limits matter for expectations. First, the trials are small and conducted largely at one institution, with short follow-up of weeks to a few months. Second, remission rates drift down over time, so a fast response does not guarantee a lasting one. A faster schedule is a quicker route to the same destination as standard TMS, not a proven shortcut to a better one.
For context on the standard course, the figures in our TMS success rate article show response rates of roughly 50 to 60 percent and remission around 30 to 40 percent for treatment-resistant depression, and our TMS therapy reviews article compares those figures with what patients report.
Are accelerated schedules safe?
Shortened schedules are generally well tolerated, with the same kinds of side effects as standard TMS: scalp discomfort, headache and facial twitching. Because patients receive more stimulation in a shorter time, discomfort and headache can be more noticeable. One randomized comparison found more patients in the accelerated group reported site discomfort and headache than in the standard group.
Seizure is the rare serious risk with any TMS. A coverage review notes that theta burst protocols have a theoretically higher seizure risk than traditional schedules because of the high-frequency bursts, which is why screening and proper protocols matter. Our article on TMS therapy side effects covers what to expect and which risk factors raise concern. Like standard TMS, these protocols do not cause memory loss and require no anesthesia.
Who is a good candidate for a faster course?
Good candidates are the same adults who qualify for standard TMS, meaning moderate-to-severe depression that has not improved enough on antidepressants, plus practical flexibility for long treatment days. Anyone who would not be safe for standard TMS is not a candidate for a faster schedule.
- You have treatment-resistant depression and have tried at least one antidepressant without enough relief
- You have no seizure history, no psychosis and no implanted metal or magnetic-sensitive devices near the head
- You can commit to several hours at the clinic for each day of an accelerated course, or can follow the schedule your clinic uses
- You want a faster course because of work, family, travel or the burden of daily commutes
- You understand the evidence is newer and that insurance may not cover it
A psychiatric evaluation decides which schedule is safe and appropriate. If you are unsure whether TMS is right at all, our treatment-resistant depression page explains how that diagnosis is made.
Is a shortened TMS course covered by insurance?
Often it is not. Cigna’s 2026 coverage policy lists accelerated protocols, including theta burst and the Stanford protocol, as experimental, investigational or unproven, while covering a standard course of 30 to 36 treatments for depression. Policies at other carriers vary, and some cover theta burst while excluding fully accelerated schedules. Under Cigna, though, theta burst stimulation itself is on the investigational list, so even a once-daily theta burst course may not be approved. MRI-guided accelerated protocols are also billed under temporary tracking codes (CPT 0889T to 0892T), which Cigna lists as experimental.
That gap means two things for you. First, ask your insurer and your clinic about coverage for the specific protocol before you commit. Second, compare the cost of an accelerated course against a covered standard course. Our guide to whether TMS is covered by insurance walks through carrier criteria, and our TMS therapy cost page explains how we help you estimate your out-of-pocket cost.
What happens after a faster course?
After a shortened course, you and your psychiatrist reassess symptoms with rating scales, usually after a few weeks, and decide whether to continue care. Some patients stay well. Others see symptoms return over weeks to months, which is why follow-up and a plan for maintenance or a repeat course should be part of treatment from the start.
Guidelines are catching up with the technology. The Canadian CANMAT guideline update in 2023 made theta burst stimulation a first-line protocol and supports accelerated intermittent theta burst as a second-line option, (Lam et al., 2024, as summarized in Cigna’s coverage policy). Standard daily TMS remains the most studied and most widely covered choice.
If a shortened course is not enough, other options exist. TMS can be combined with psychotherapy, and some patients move on to Spravato or ketamine-based care. If you are weighing TMS against ECT, see our TMS vs ECT comparison, and if you are weighing coil types, see deep TMS vs standard TMS.
What does a SAINT treatment day look like at centers that offer it?
Patients considering SAINT often ask what the week involves. A SAINT day is long but simple. You arrive at the clinic, receive a short stimulation session of roughly ten minutes, rest for about 50 minutes, and repeat that cycle ten times, so the day can fill much of a working schedule. Most patients read, work on a laptop, eat lunch or relax between sessions. You go home each evening and return the next day for five days.
Practical planning matters more than most people expect. Arrange time off or flexible work for the full week, line up a ride or lodging if you live far from the clinic, and bring whatever helps you pass the waiting time comfortably. Many patients find that one intense week is easier to organize than six weeks of daily commutes, while others find the long days tiring, so be honest with your care team about which pattern suits you.
Why do many insurers treat shortened schedules as investigational?
Insurers classify accelerated protocols as investigational mainly because the evidence is thinner and shorter than for standard daily TMS. Cigna’s review of accelerated TMS studies describes small trials, heterogeneous protocols and short follow-up of weeks to a few months, with conflicting results. In one randomized trial comparing an accelerated schedule with a standard four-week course, response and remission did not differ significantly between the two.
That finding cuts both ways. It suggests an accelerated course can deliver a comparable result in less time, which is the whole point, and it also means the evidence does not show accelerated schedules working better. For payers, a treatment must be shown to improve health outcomes, and speed alone is not an outcome they reimburse. Expect this stance to shift as larger trials and longer follow-up accumulate.
What should you ask a clinic about faster schedules?
- Which exact protocol do you deliver, how many sessions per day and in total, and how far apart are they?
- How is the treatment site chosen, by scalp measurement or by brain imaging?
- What outcomes do you track, and what share of your patients respond or reach remission?
- What will my insurance pay, and what will I owe out of pocket for this schedule versus a standard course?
- What happens if I do not improve, and do you offer maintenance or repeat courses?
A clinic that answers these directly, including the uncomfortable ones about coverage and durability, is easier to trust than one that promises a cure in a week.
How do you decide between standard and accelerated TMS?
Bring these questions to your consultation:
- How much time can I realistically give each week, and could I handle full days for a short course?
- What does my insurance cover, and what would I pay out of pocket for each schedule?
- Which protocols does this clinic deliver, and what outcomes does it track for each?
- What is the plan if I relapse, including booster sessions or a repeat course?
If speed matters most and cost is manageable, a shortened course may be worth discussing. If coverage and the deepest evidence base matter most, a standard course remains the straightforward choice. At Village TMS, we provide the standard course. In a free consultation we can review your history, explain how standard TMS compares with the faster options in this guide, and verify what your plan will cover.
You can also find a TMS provider near you or read our overview of what TMS therapy is before your consultation.
Call 646-817-2835 or contact us to book a free consultation.
