# The Effects of Stanford Accelerated Intelligent Neuromodulation Therapy on Explicit and Implicit Suicidal Cognition

> **NIH NIH R01** · STANFORD UNIVERSITY · 2021 · $619,242

## Abstract

ABSTRACT
The overarching aim of this proposal is to test the efficacy and safety of a highly efficient and personalized
repetitive transcranial magnetic stimulation (rTMS) method, termed Stanford Accelerated Intelligent
Neuromodulation Therapy (SAINT). In this proposal, we will utilize SAINT as a rapid-acting intervention for the
reduction of explicit and implicit suicidal cognition within the context of an emergency psychiatric admission for
suicidal thoughts and behaviors. Although rTMS is FDA approved for treatment-resistant depression (TRD), the
average required treatment application is 6 weeks before signs of symptomatic improvement, which is not an
optimal strategy for symptomatic treatment of an acute suicidal crisis. This application is motivated by three
recent findings in the neuromodulation field. First is a sham-controlled pilot study evaluating an accelerated
conventional rTMS protocol, where multiple stimulation sessions were safely delivered to the left dorsolateral
prefrontal cortex (L-DLPFC) across three days in patients with suicidal ideation. This study demonstrated that
conventional rTMS can be ‘accelerated’ as well as demonstrated a signal of reductions in explicit suicidal
cognition. Second, there are two notable randomized trials of intermittent theta-burst stimulation applied to the
L-DLPFC that demonstrated the efficacy of intermittent theta burst stimulation (iTBS) as a treatment for TRD, a
condition commonly associated with suicidal cognition. iTBS has been demonstrated to have 5X the pulse
potency of conventional rTMS, which allows for a much-reduced stimulation session time in comparison to
traditional rTMS and therefore makes multiple treatments per day a feasible intervention. The final innovation is
that rTMS targeting utilizing resting state functional connectivity improves antidepressant outcomes of rTMS. We
designed an approach, which we termed SAINT, which utilizes numerous applications of iTBS per day, as per
principles of spaced learning theory (optimized intersession-intervals), within a functional connectivity derived
target (L-DLPFC-sgACC). In TRD, we have observed dramatic changes in mood and associated explicit suicidal
cognition using SAINT. We propose utilizing SAINT to modulate the neural circuitry that underlies explicit and
implicit suicidal cognition along with moderators/mediators (hopelessness, anhedonia, and depression). We will
conduct a randomized, controlled trial of SAINT applied to the L-DLPFC-sgACC to assess efficacy of the
approach in reducing suicidal cognition in hospitalized psychiatric inpatients.

## Key facts

- **NIH application ID:** 10263271
- **Project number:** 5R01MH125160-02
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Nolan R. Williams
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $619,242
- **Award type:** 5
- **Project period:** 2020-09-15 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10263271

## Citation

> US National Institutes of Health, RePORTER application 10263271, The Effects of Stanford Accelerated Intelligent Neuromodulation Therapy on Explicit and Implicit Suicidal Cognition (5R01MH125160-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10263271. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*