Repetitive Versus Deep Transcranial Magnetic Stimulation for Major Depression

Inclusion Criteria:

• Diagnosis of Major Depressive Disorder, at least moderate intensity, single orrecurrent episode

• HRSD-17 score of at least 18

• No improvement to at least two adequate courses of antidepressants (based on theATHF) or were unable to tolerate at least two separate trials of antidepressants ofinadequate dose and duration

• On a stable antidepressant regimen for the past four weeks before screening

• Patients with a chronic depressive episode >2 years and who have previously receivedECT or ketamine will be eligible to participate

Exclusion Criteria:

• Having previously received TMS;

• Substance use disorder within the last three months

• Diagnosis of bipolar or psychosis spectrum disorder

• Anxiety or personality disorder that is assessed by a study investigator to be theprimary cause and causing greater impairment than MDD

• Concomitant major unstable medical or neurological illness

• Intracranial implant, cardiac pacemaker or implanted medication pump

• Significant laboratory abnormality;

• Active suicidal intent

• Pregnancy

• If participating in psychotherapy, must have been in stable treatment for at leastthree months before entry into the study, with no anticipation of change

• Currently taking more than the equivalent of 2 mg of lorazepam of a benzodiazepinedaily or any dose of an anticonvulsant due to the potential to limit TMSeffectiveness