Open Label Optimization Study

Inclusion Criteria:

1. Adult males or females, 18 and older, who have failed to receive satisfactoryimprovement from prior antidepressant medication in the current episode.

2. Confirmed primary clinical diagnosis of major depressive disorder (MDD) withoutpsychotic features consistent with DSM-V criteria.

3. No medical conditions that would preclude the safe use of TMS.

4. Primary psychiatrist has determined TMS to be an appropriate clinical option.

5. Able to provide consent and comply with all study requirements.

6. Negative pregnancy test at the intended time of SAINT™ 5-day acute course treatmentand agreement to use effective birth control during SAINT® acute therapy.

Exclusion Criteria:

1. Have any contraindication to TMS (section 2 User Manual).

2. Have any contraindication to receiving an MRI

3. Participants with an abnormal brain MRI as determined by PI, study physician ordesignee.

4. Deemed by the PI, study physician or designee to be a high risk of suicide or hasmade a suicide attempt within the last 6 months.

5. Treatment dose with cortical depth adjustment is greater than 120% motor thresholdand cannot be completed.