Accelerated iTBS for Depression and Suicidality

Inclusion Criteria: * • Ability to provide informed consent * Availability for the duration of the study and willingness to comply with all study procedures * Age 18 to 90 * Diagnosis of major depressive disorder by DSM-5 criteria * Depressive symptoms are thought to be caused primarily by a major depressive episode and not by some other neurologic or psychiatric illness * Failure of or intolerance to at least 2 antidepressant treatments of different therapeutic classes (can include psychotherapy trial or neurostimulation trial) * Meets criteria for clinical eligibility for ECT treatment, including optimization of any medical conditions and completion of any medical testing or clearance as clinically indicated * Able to consent voluntarily to treatment * Score of at least 2 on the MADRS item 10 * Ability to sit or lie down for an extended period of time and willingness to adhere to the theta burst stimulation protocol Exclusion Criteria: * • Presence of implanted ferromagnetic devices or materials, including cardiac pacemaker, cochlear implant, deep brain stimulation device, vagus nerve stimulation device, shrapnel, facial or scalp piercings that cannot be removed, or metallic face or head tattoos * Pregnancy or lactation * Previous bad reaction or intolerance to transcranial magnetic stimulation * Febrile illness within 1 week * Treatment with another investigational drug or other intervention within 30 days * Recent substance abuse or use di…