a-rTMSIn-patient SCC TMS

Inclusion Criteria:

1. All subjects must be between 18-65 years of age.
2. Must have confirmed diagnosis of moderate to severe Major Depressive Disorder (single or recurrent episode) as defined by a HAM-D score of 17 or higher.
3. Failure to respond to a minimum of 2 trials of antidepressant medication
4. Failure to respond from at least two different agent classes
5. Accompanied by at least two evidence-based augmentation therapies (Benzodiazepines do not count).
6. Must have a trial of psychotherapy known to be effective in the treatment of MDD of an adequate frequency and duration.
7. Subjects are willing and able to adhere to the accelerated treatment schedule.

Exclusion Criteria:
8. Are mentally or legally incapacitated, unable to give informed consent
9. Have an infection or poor skin condition over the scalp where the device will be positioned
10. Have increased risk of seizure because of family history, stroke, or currently use medications that lead to increased risk for seizure
11. Diagnosis of acute or chronic psychotic symptoms or disorders (such as schizophrenia, schizophreniform or schizoaffective disorder) in the current depressive episode.
12. Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, having a history of repetitive or severe head trauma, or with primary or secondary tumors in the central nervous system.
13. Presence of an implanted magnetic-sensitive medical device present in the body scan, including but not limited to a cochlear implant, implanted cardioverter defibrillator, pacemaker, vagus nerve stimulator, or metal aneurysm clips or coils, staples, or stents. (Note: Dental amalgam fillings are not affected by the magnetic field and are acceptable for use with transcranial magnetic stimulation and MRI.)