Transcranial Magnetic Stimulation in Veterans With PTSD

Inclusion Criteria:

* Age between 19 and 70
* Eligible for VA healthcare
* Moderate to severe PTSD as determined by a total score of at least 25 on the CAPS within 7 days of randomization.
* Agree to have CAPS audio recorded.
* Ability to obtain a Motor Threshold using the TMS device during screening.
* If female with childbearing potential, use of acceptable method of birth control (i.e., use of contraceptives, abstinence).
* Able to read, understand, and sign the informed consent document.

Exclusion Criteria:

* Pregnant or lactating woman.
* MRI is contraindicated
* Current use of clozapine (any dose) or bupropion (more than 300mg per day).
* Cardiac pacemaker or implantable defibrillator.
* Presence of any metal object in the head, including cochlear implants, but excluding dental work in the mouth.
* Significant central nervous system disorder (stroke, brain mass, epilepsy).
* Seizure in past one year.
* Current psychosis or mania.
* Significant suicidal ideation.
* Unstable medical conditions.
* Current alcohol or substance use disorder (except nicotine) that interferes with the patient's ability to participate.
* CPT or PE for PTSD in the past 2 months.
* Changes in Fluoxetine, Paroxetine, Sertraline, or Venlafaxine in the past 2 months.
* Color blind
* Currently participating in other research studies.
* Aneurysm Clip
* Ocular foreign body (e.g., metal shavings)
* Any implanted device (pumps, infusion devices, etc.)
* Shrapnel injuries or metal fragments