Accelerated LFR for Bipolar Patients During the COVID-19 Pandemic

Inclusion Criteria: * Currently are experiencing a bipolar depressive episode (bipolar disorder type 1 or 2) based on the MINI with or without psychotic symptoms * Have previous response to ECT or high symptom severity warranting acute ECT in the opinion of one of the brain stimulation psychiatrists * Are over the age of 18 * Pass the TMS adult safety screening (TASS) questionnaire * Are voluntary and competent to consent to treatment Exclusion Criteria: * have a Mini-International Neuropsychiatric Interview (MINI) confirmed diagnosis of substance dependence or abuse within the last 1 month * Currently experiencing a mixed or manic episode (YMRS \>12) * have a concomitant major unstable medical illness, cardiac pacemaker or implanted medication pump * have a lifetime Mini-International Neuropsychiatric Interview (MINI) diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder * have any significant neurological disorder or insult including, but not limited to: any condition likely to be associated with increased intracranial pressure, space occupying brain lesion, any history of seizure except those therapeutically induced by ECT or a febrile seizure of infancy or single seizure related to a known drug related event, cerebral aneurysm, significant head trauma with loss of consciousness for greater than 5 minutes * have an intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any othe…