Cortical rTMS as a Treatment for Depression

Inclusion Criteria:

1. Be male or female aged 18-64 years old.
2. Has depressive symptoms according to the PHQ-9 or MADRS or HDRS or SHAPS
3. Be able to verbalize understanding of consent form, able to provide written informed consent, and verbalize willingness to complete study procedures
4. Female subjects must be non-nursing and not pregnant at the times of fMRI experiments and TMS treatment
5. Has no contraindications to MRI (pacemaker, cochlear implants, metal in eyes, other metal implants, etc.); Meets the pre-screening MRI questions provided by the Center for Advanced MR Imaging (CAMRI)
6. Has no contraindications to TMS (any types of non-removable metal in their head except the mouth, or within 12 inches of the coil, etc.); Meets the pre-screening TMS safety questionnaire (Transcranial Magnetic Stimulation Adult Safety Screen - TASS)
7. stabilized with medication treatments (e.g., methadone or buprenorphine) or abstinent from opioids if patients are seeking transition to naltrexone
8. urine toxicity test is negative for specific drugs (e.g., opioids)

Exclusion Criteria:

1. In the opinion of the clinician and/or the research team, be expected to fail to complete the study protocol due to not tolerable to receive TMS
2. Unable to understand the design and requirements of the study;
3. Unable to sign informed consent for any reason
4. Has an unstable medical condition, including AIDS, acute hepatitis, active TB, unstable cardiac disease, unstable diabetes, hepatic or renal insufficiency
5. Female subjects who are pregnant or nursing
6. Contraindications to MRI (pacemaker, cochlear implants, metal in the eye, other metal implants, etc.): Do not meet the pre-screening MRI questions provided by the CAMRI at BCM
7. Contraindications to TMS (any types of non-removable metal in their head except the mouth, or within 12 inches of the coil, etc.): Do not meet the pre-screening TMS safety questionnaire (TASS). Additional exclusion criteria for the TMS experiments are based on the recommendations described by the international consensus panel on brain stimulation
8. Non-English speaking subjects (we do not have the staff and/or resources to include other languages);
9. Unstable with medication treatments (e.g., methadone or buprenorphine)
10. urine toxicity test is positive for specific drugs (e.g., opioids)
11. currently on seizure medications (e.g., Depakote)