rTMS for Treatment of Depressed Phase of Bipolar Disorder Type II

Inclusion Criteria: * Male and female outpatients aged 18-55 years old * Meet DSM-IV criteria for Bipolar Affective Disorder Type II, depressed phase without psychosis as determined by Structured Clinical Interview for DSM-IV * A MADRS ≥ 15 at Initial Visit, and at Prior to TMS Evaluation * A Young Mania Rating Scale \< 12 at Initial Visit and at Prior to TMS Evaluation * Duration of current episode of depression \>2 months but ≤ 1 year of unsuccessful treatment * On stable medication and/or psychotherapy for 1 month and clinically appropriate to maintain for duration of trial * Cognitively intact (Folstein MMSE score \>24). * Clinically competent to give informed written consent Exclusion Criteria: * History of epilepsy or seizure disorder, mass brain lesions, cerebrovascular accident, metal in the skull, a history of major head trauma, or any neurologic condition likely to increase risk of rTMS. * Suicidal risk that precludes safe participation defined as score of 5 or 6 on MADRS item 10 Suicidal Thoughts or clinical impression that the subject is at significant risk for suicide. * History of any DSM-IV Axis I diagnosis other than Bipolar Affective Disorder Type II, depressed phase, simple phobia and generalized anxiety disorder (GAD) in the last year * Lifetime history of schizophrenia, schizoaffective, or other psychotic disorder, bipolar disorder type I, dementia, dissociative disorders, and sexual and gender identity disorder * Personality disorder that makes participation in the trial difficult * Greater than or equal to 8 episodes of mood disturbance in the previous 12 months * Greater than 4 unsuccessful treatments in current episode * History of Substance Abuse or Dependence (DSM-IV) in the last year except nicotine and caffeine * Positive urine drug test during screening * Taking any medication that significantly lowers the seizure threshold (e.g. lithium, stimulants, bupropion, TCAs, antipsychotics, theophylline, etc.) * Unstable medical conditions that precludes safe participation in rTMS treatment trial * Known or suspected pregnancy * Women of child-bearing potential not using medically accepted form of contraception when engaged in sexual intercourse * Any metal or device implants that would increase risk of rTMS * Unable to determine the motor threshold in the subject * History of Vagus Nerve Stimulation * Currently in another investigational study * Prior electroconvulsive therapy failure