A Pilot Study on Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment of Bipolar Depression

Inclusion Criteria: * bipolar I or II patients, currently in a depression episode * Patient must have failed at least 2 medication * Score of 21-item Hamilton Rating Scale for Depression (HAM-D) Exclusion Criteria: * Rapid cycling bipolar or mixed episode of mood disorder by definition of current DSM criteria * Substantial risk of suicide during the screening period that requires inpatient care * Presence of psychosis * Dual diagnosis of other primary, currently clinically significant severe mental disorders * History of other significant neurological diseases, such as seizure disorder, stroke, brain tumors, abnormalities in the blood vessels in brain, dementia, Parkinson's disease, Huntington's chorea or multiple sclerosis * History of any medical event that may increase the risk of having seizure, such as head trauma with unconsciousness for more than 5 minutes or a family history of seizure * Significant medical complications that may deteriorate during the trial or have increased likelihood of danger consequences * Patients who are pregnant or intend to become pregnant during the study period * Any metallic prosthesis in head, neck or upper body (including cardiac pace maker) that cannot be safely removed during treatment * Current Vagus Nerve Stimulation (VNS) treatment or Electroconvulsive Therapy (ECT) treatment, or with history of failed ECT treatment * Patient's Motor Threshold for TMS cannot be detected * Significant side effects which are intolerable during the screening or any later stage of the trial * Started psychotherapy within the previous 8 weeks or foreseeable psychotherapy will be started or changed in 6 weeks