Efficacy of rTMS in Bipolar Depression

Inclusion Criteria:

• Are a male or female aged 18 to 70 years.

• Have a diagnosis of Bipolar Disorder with a current ongoing episode of depression.

• Are not currently experiencing a mania.

• Have failed to achieve a clinical response or have been unable to tolerate anadequate dose of at least one of the medications used for treating Bipolardepression

• Are taking an anti-manic agent (lithium or valproate) or an atypical antipsychotic (quetiapine, lurasidone, aripiprazole, ziprasidone, risperidone, olanzapine), or acombination of the above, or a combination of any of them with lamotrigine 100-400mg daily. Lamotrigine alone for bipolar II disorder is permitted.

• current medications have been at a stable dose in the 2 weeks prior to randomization

• Are capable of understanding, consenting to, and complying with the requirements ofthe study

Exclusion criteria:

• Have an alcohol or substance abuse or dependence within the last 3 months.

• Are at a significant risk of harm to themselves or others

• Are pregnant or planning on becoming pregnant in near future or lactating.

• Have a personal or family history of seizures.

• Have a history of unstable or inadequately treated medical illnesses, includingmoderate to severe brain injury or head trauma.

• Have a primary diagnosis of other psychiatric disorders (other than Bipolar) orpersonality disorders that are of primary concern and causing greater impairmentother than bipolar disorder.

• are currently taking more than 3 of the antipsychotics.

• Have failed a course of ECT in the current episode.

• History of non-response to rTMS treatment.

• If participating in psychotherapy, you must have been in stable treatment for atleast 3 months prior to entry into the study,

• Currently (or in the last 4 weeks) taking more than 2 mg daily (or equivalent) oflorazepam or any dose of medication for seizures

• Have a pacemaker, or an implant (e.g., aneurysm clips, shunts, stimulators, cochlearimplants, or electrodes) or any other metal object within or near the head,excluding the mouth that cannot be safely removed.

• Have a non-correctable clinically significant sensory impairment (i.e., cannot hearwell enough to cooperate with interview).