New therapy provides hope for those with severe depression

This story first appeared in Healthy You - July 2025, The Gazette’s quarterly health publication.

Research studies and polls show that approximately 20 percent of adults in the United States will be diagnosed with depression at some time in their lives. While many people with depression will find relief through psychotherapy or antidepressant medications, these interventions don’t work for everyone.

“A person may have been in and out of treatment and nothing seems to work,” said Dr. Nick Trapp, assistant professor of psychiatry at the University of Iowa. Despite medical treatments, people with treatment-resistant depression continue to suffer with symptoms like persistent feelings of sadness or hopelessness, sleep disruptions, feelings of worthlessness or guilt, or even thoughts of suicide.

Now, another option beyond medication and psychotherapy provides hope for relief from the symptoms of severe depression.

This new therapy, Stanford accelerated intelligent neuromodulation therapy, or SAINT® neuromodulation therapy, uses transcranial magnetic stimulation (TMS), a non-invasive technique that can make changes in the way neurons in the brain work. In this type of therapy, electro-magnetic pulses change the brain’s activity, all without having to use surgery or other invasive means.

“This therapy makes your brain more able to remap itself,” Trapp said. Normally, the brain resists remapping. However, “when the brain is in a pathological state [like major depressive disorder], it’s important to make those changes.”

In severely depressed patients, researchers have found decreased brain activity in the dorsolateral prefrontal cortex, the part of the brain right behind the forehead on the left. Transcranial magnetic stimulation gives physicians the opportunity to stimulate more activity in that area, essentially to wake up that part of the brain to get it functioning normally again.

Electromagnetic pulses are effective ways to treat brains, because our brains already use electrical pulses.

“Your brain communicates both through using electrical energy that passes through neurons, and through the release of chemicals,” Trapp said. In the synapses, the gaps between neurons, chemical or electronic signals are used to transmit information from one neuron to the next.

“Medical antidepressants affect the chemical connections between neurons,” Trapp said. “[TMS] affects the electronic impulses.”

For patients, TMS treatment is straightforward. The patient is seated in a comfortable recliner chair with a pillow to steady their head and neck. The doctor positions the coil, which looks like a waffle iron, next to the patient’s head. This coil sends out electromagnetic pulses that pass through the skull and into the brain.

“When you pass electricity through the coil, it creates a focused magnetic field at the site where we’re targeting,” Trapp said. “It creates electrical energy in the brain and gets the neurons in the brain to fire.”

Despite the changes going on in the brain, there’s no pain involved. Most patients don’t feel anything other than a light tapping feeling. There are no cognitive side effects either, like memory loss or distress.

The patient returns for a prescribed number of visits to have the procedure repeated, usually once a day, every day, for six weeks.

“Most of the patients can tell that the procedure is working as they go through the series of treatments,” Trapp said.

Psychiatrists have been prescribing TMS for patients with depression since 2008, and recent innovations have made the procedure more targeted and more efficient.

Stanford accelerated intelligent neuromodulation therapy, or SAINT®, developed at Stanford University, uses condensed and targeted treatment to make the TMS procedure even more efficient and effective. Trapp came to the University of Iowa after working with the developer of this improved procedure at Stanford University. His expertise means that the University of Iowa is one of the first academic centers to offer the therapy.

One improvement that SAINT therapy offers is more targeted electromagnetic pulses.

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“We used to measure the patient’s skull to figure out where to stimulate,” Trapp said. “Now the patient gets an MRI scan first to identify the exact location in their brain that needs to be targeted. This has allowed us to improve the precision. We use the scan to carefully determine exactly where to aim the electromagnetic pulses.”

Not only that, but SAINT treatment can condense the course of treatment for patients. Standard TMS treatment requires daily visits to the hospital to receive treatments that might last up to 40 minutes each.

The SAINT version of TMS condenses the treatment using what’s called a theta burst protocol. It quickly delivers electromagnetic pulses to the area in less than a tenth of the time of the old procedure: rather than taking 40 minutes, the procedure can take as little as three minutes.

Because of the condensed procedure, patients now have an option of getting the whole sequence of treatments over the course of five days, rather than once a day for six weeks. The patient can get treated once an hour for 10 hours over the course of five consecutive days.

“Treatment takes just 10 minutes,” Trapp said. “They then can rest and relax at the hospital until the next hour.” For people who would otherwise have to travel long distances to the hospital, this is an appealing option.

“People respond faster with this condensed treatment,” Trapp said. “Within two and a half days, most are starting to feel better. Within a month, more than 80 percent had remission of symptoms.”

TMS does not end a patient’s depression forever. Most patients will have to return for repeat treatment anywhere from six months to two years later, and regularly thereafter. Those who responded well to the treatment once are likely to respond well again.

For patients and for their health care providers, TMS — and SAINT, specifically — is a game-changer.

“We see some of the sickest patients,” Trapp said. “This may feel like a last-ditch response. But it is amazing seeing these people where nothing has been able to work.”

Eventually, TMS and SAINT might be standard procedure options for anyone with major depressive disorder. But for now, Trapp and his colleagues are glad to provide the procedure for patients who need it.

“We are giving them a sense of hope and coming up with alternative options for them,” Trapp said. “That’s what we’re all about: finding hope for these patients.”