Accelerated Intermittent Theta Burst Stimulation for Inpatients With Major Depressive Disorder (aiTBS)

This study intends to investigate whether modifying stimulation parameters enables typical
6-8 week long rTMS protocols to be compressed to only five days. The influence of this
accelerated protocol on the length of patient stay in the hospital and the direct total cost
will be investigated.

Inclusion Criteria:

- Admitted to the psychiatric inpatient unit with a diagnosis of MDD and displaying
suicidal ideation [elevated scores on the scale of suicidal ideation (SSI; scores of 5
or more)]

- Motor threshold value which enables treatment.

- Qualifies and has access to outpatient rTMS treatment

- If older than 70, MRI needs to be analyzed to confirm eligibility-no atrophy or
lesions etc

Exclusion Criteria:

- Primary diagnosis other than MDD.

- Any structural neurological condition

- Metal implant in brain (e.g. deep brain stimulation), cardiac pacemaker, or cochlear

- History of epilepsy/ seizures (including history of withdrawal/ provoked seizures)

- Pregnancy

- Autism Spectrum disorder

- Active substance use (<1 week) or intoxication verified by toxicology screen--of
cocaine, amphetamines, benzodiazepines

- Cognitive impairment (including dementia)

- Current severe insomnia (must sleep a minimum of 5 hours the night before stimulation)

- Current mania

- Current unmanageable psychosis

- IQ <70

- Any other indication the PI feels would comprise data.

- Undetermined parkinsonism or Parkinson's patients who are not taking levodopa.

- More subcortical lesions than would be expected for age or a stroke effecting
stimulated area or connected areas.