rTMS for MDD: 5.5cm Rule vs. F3 Targeting

Currently there is little standardization between rTMS treatment programs as to what is the
best way to localize the left dorsolateral prefrontal cortex, which is the FDA-approved
treatment location for clinical rTMS for major depressive disorder (MDD). Different targeting
methods yield locations that can vary by up to a few centimeters. By comparing different
treatment locations and obtaining neurobehavioral, neuroimaging, cognitive, and
neuropsychological measures, this study would provide the opportunity to identify the optimal
treatment targeting method when using rTMS for major depressive disorder in a clinical
setting. This study will specifically be focusing on comparing the two most common targeting
methods: a target 5.5cm anterior to the motor strip on the left prefrontal scalp and the F3
target location on the left prefrontal scalp as identified using the 10-20 EEG system
nomenclature.

Inclusion Criteria:

- Diagnosis of major depressive disorder

- Age between 18 and 90 years

- rTMS is clinically indicated as determined by clinical rTMS physician team at
University of Iowa

Exclusion Criteria:

- rTMS contraindication such as implanted ferromagnetic material in the head or history
of epilepsy with poorly controlled seizures

- MRI exclusion criteria (if participating in MRI portion of study) including implanted
device such as:

- Pacemaker

- Coronary Stent

- Defibrillator

- Neurostimulation

- Or any of the following conditions:

- Claustrophobia

- Uncontrolled high blood pressure

- Poorly controlled atrial fibrillation

- Significant heart disease

- Hemodynamic instability

- Severe kidney disease

- Pregnant, trying to become pregnant, or breast feeding