Enhanced Spatial Targeting in ECT Utilizing FEAST

Inclusion Criteria: * Diagnosis of major depressive disorder using MINI-7 to derive RDC; DSM-IV * Pretreatment HRSD score greater than or equal to 18 * ECT indicated by physician evaluation * Willing and capable of providing informed consent as determined by physician evaluation Exclusion Criteria: * History of schizophrenia, schizoaffective disorder, other functional psychosis, or rapid cycling bipolar disorder as determined by MINI-7; rapid cycling defined as greater than or equal to four episodes in past year * History of neurological illness or insult other than conditions associated with psychotropic exposure (e.g., tardive dyskinesia) determined by physician evaluation and medical history * Alcohol or substance abuse or dependence in the past year (RDC) determined by physician evaluation * Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-IV), pregnancy, or epilepsy determined by physician evaluation * Requires especially rapid antidepressant response due to suicidality, psychosis, inanition, psychosocial obligations, etc. determined by physician evaluation * ECT in the past six months determined by physician evaluation and medical history * Pregnancy as determined by urine pregnancy test and clinical interview