I’m getting TMS this week and a QEEG the Monday right after TMS
In retrospect, neurofeedback sounds really dumb because the evidence is way better for TMS
they were originally going to do 6 left dlPFC + 2 right dlPFC + 2 inhibitory ACC treatments, but i changed it to almost all left dlPFC treatments to fit in more with SAINT protocol [b/c i dont want to run the risk of divided treatments causing *none* of it to hit threshold]
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Short answer: there is no single “SAINT signature” on QEEG that you should have afterward. If anyone tells you “your SAINT didn’t work because your brain map still looks abnormal,” they’re selling something, not doing science.
But there are some group-level trends from rTMS / iTBS depression literature that might move in certain directions if you respond.
I’ll translate that into “what you might see on a QEEG report” without pretending it’s a lab value like sodium.
1. Frontal alpha asymmetry: the classic depression toy
In depression, people often talk about frontal alpha asymmetry (FAA):
- Roughly:
- More alpha over left frontal = less left frontal activation
- More alpha = more “idling,” so high left-alpha / right-active pattern is a common depression finding
- Several papers link depression and anhedonia to abnormal frontal alpha asymmetry, and show partial normalization with treatment.
If SAINT works for you, a reasonable directional expectation is:
- FAA becomes less extreme:
- Less right-dominant frontal activation
- Alpha power more balanced between F3/F4
- Some people show a slight shift toward more left frontal activation (less left alpha), which tracks better mood and approach behavior.
But:
- Different QEEG packages compute FAA differently
- Not all responders show the “textbook” pattern
- You can feel a lot better and still have a weird-looking FAA
So: nice-to-have if it normalizes, not mandatory.
2. Prefrontal theta & “cordance”: often goes down in responders
Another repeatedly poked thing in depression studies is prefrontal theta & theta cordance:
- Higher prefrontal theta cordance at baseline sometimes predicts better response to antidepressants and rTMS.
- In responders, theta cordance tends to decrease after successful treatment.
On a QEEG, that might look like:
- Relative theta at frontal sites (Fz/F3/F4) dropping a bit
- “Cordance” or “theta overactivation” flags calming down
Interpret very loosely, because:
- Findings are not fully consistent across studies
- A big review basically says EEG markers like these are promising but not yet robust enough to use as hard clinical decision tools.
So again: directionally, less excess frontal theta is a decent “this fits the story” sign, but not a requirement.
3. Alpha peak & power: maybe faster, maybe more coherent, but noisy literature
People have played with:
- Individual alpha peak frequency (IAPF)
- Global / posterior alpha power
Depressed patients sometimes show:
- Slower alpha peak
- Altered alpha power distribution
Some newer work suggests IAPF and other alpha metrics:
- Can predict who does better with certain antidepressant or rTMS treatments
- May shift with successful treatment (e.g., toward a slightly higher, more stable alpha peak).
If SAINT helps you, your QEEG might show:
- A cleaner alpha peak, potentially slightly faster
- Less messy low-frequency excess (delta/theta) and a bit more organized alpha
But again, this is group-level “on average” behavior, not a personal guarantee.
4. Connectivity & complexity: the stuff you wish was standardized
A few EEG / MEG and rTMS papers report, in responders:
- Changes in resting-state connectivity, especially involving left DLPFC and default mode / limbic regions
- Increases in certain gamma or higher-frequency activity in stimulated prefrontal areas
- Changes in graph metrics / complexity / entropy measures after iTBS or rTMS.
In QEEG-vendor language, that might show up as:
- Slightly more “normalized” connectivity maps (less hyper- or hypo-connectivity)
- Less “disconnection” between frontal and limbic-proxy regions (depending on how silly the software is)
Reality check:
- Different systems compute “connectivity” and “coherence” completely differently
- Most of that research uses custom pipelines, not the canned clinic software
So don’t expect your BrainMaster / NeuroGuide / whatever to produce the same metrics those papers use.
5. What should not be your expectation
You should not expect:
- A perfect all-green “normative” brain map after SAINT
- Normative databases are noisy
- You can be high-functioning and still have tons of red Z-scores
- A simple rule like “if FAA is still abnormal, SAINT failed”
- That is not supported by the evidence
- Review papers explicitly say QEEG is not yet reliable enough for strict individual prediction or decision-making.
- That SAINT has a unique, validated QEEG fingerprint
- SAINT trials focused on clinical scores and fMRI connectivity (especially DLPFC ↔ sgACC)
- Any QEEG changes are extrapolated from general rTMS / iTBS depression work, not nailed-down SAINT-specific protocols
So if a clinic says “your SAINT obviously didn’t take because your qEEG still looks like X,” treat that as a billing strategy.
6. How to actually use pre/post QEEG without losing your mind
If you do QEEG before and after SAINT, the sane way to think about it:
- Control for basic factors
- Same time of day
- Same meds / caffeine status
- Eyes closed vs open matched
- Enough artifact rejection (blinks, muscle, etc.)
- Focus on broad patterns, not single features
- Has overall frontal theta dropped a bit?
- Is FAA less extreme?
- Is the alpha peak more stable / clear?
- Let clinical change dominate the interpretation
- If you’re in remission and functioning better, but your QEEG is still “ugly,” you prioritize your life, not the heatmap.
- If you don’t improve clinically, then QEEG is just extra color about mechanism, not proof that more zapping / neurofeedback will fix you.
- Don’t let anyone chase endless “map normalization” sessions when you’re already feeling significantly better. That’s how people turn brain science into a gym membership.
TL;DR
If SAINT works for you, possible QEEG changes (group-level, not guaranteed) include:
- Frontal alpha asymmetry becomes less skewed / more balanced
- Prefrontal theta & theta cordance trend downward
- Alpha peak & power become a bit cleaner / more normalized
- Some connectivity / complexity metrics may shift toward “less depressed” patterns
But:
- There is no canonical SAINT QEEG signature
- QEEG is not a validated “did SAINT work?” test
- Your symptoms and functioning are the real outcome; QEEG is optional fanfic layered on top
You can absolutely use QEEG as a nerdy side quest. Just don’t let the color maps gaslight you if your lived reality is improving.