Repetitive Transcranial Magnetic Stimulation for Treating Depression: A Functional Magnetic Resonance Imaging Study

Inclusion Criteria:

SCREENING/DIAGNOSTIC REQUIREMENTS:

• Male or female outpatients, ages 18-50 (some literature has shown increasing cortical distance with age that may affect treatment outcome
• Hamilton Rating Scale of Depression (HRSD-24) > 18
• New onset major depression or untreated recurrent major depression per DSM-IV-TR38 criteria.
• Not taking antidepressant medication or any other psychotropic medication
• Using an adequate contraceptive method
• Able to give informed consent
• Available for 4 weeks of daily therapy, working hours, Mon.-Fri.
• English-speaking

Exclusion Criteria:

DIAGNOSTIC EXCLUSIONS:

• Co-morbid psychiatric diagnosis of bipolar disorder, acute OCD, schizophrenia or schizoaffective or concurrent treatment with outpatient ECT, or personality disorder or MDD with suicidal ideation as determined by history and/or by P.I. examination requiring hospital admission or referral for acute care.
• Previous failure to respond to treatment with rTMS
• Failure to achieve satisfactory improvement in depression after two or more adequate trials of antidepressant medications.

MEDICAL EXCLUSIONS:

• Patients newly diagnosed with thyroid dysfunction
• History of drug and/or ETOH dependence
• History of seizures
• History of head injury with loss of consciousness > 5 minutes
• Any implantable metal object in the skull or near their head
• Any implantable devices such as a cardiac pacemaker, vagal nerve stimulator, etc.
• Positive urine pregnancy test
• Severe migraine headaches uncontrolled with routine non-narcotic medication
• Any medical condition in the opinion of the Investigator that might confound the results of the study Contraindications to fcMRI procedure
• Intake of NSAIDS, narcotic or muscle relaxants within 72 hours of the fMRI protocol.
• Claustrophobia.
• Left-handedness (may influence cerebral cortical hemispheric dominance).
• Inability to tolerate, or medical contraindication to MRI testing (e.g. metal prostheses or implants, history of claustrophobia)

PROTOCOL SPECIFIC EXCLUSIONS:

• Unable to determine motor threshold for determining treatment dose with rTMS device
• Mini Mental Status Exam (MMSE)70 score < 24.