Repetitive Transcranial Magnetic Stimulation for Treating Resistant Bipolar Depression

Inclusion Criteria: * Men or women aged 18 to 70 years * Current major depressive episode (MDE) in the context of a bipolar disorder type I or II (according to the DSM-IV-TR) that has not improved after more than 2 adequate pharmacological trial(s) in the current episode (failure is defined as a lack of significant clinical improvement after the use of standard mood stabilizers, atypical antipsychotics and/or antidepressants given at their minimum effective dosage or higher for at least 4 weeks of duration) * Baseline score ≥ 13 on the Quick Inventory of Depressive Symptomatology - Clinician-Administered (QIDS-C), i.e., a MDE of at least moderate intensity Exclusion Criteria: * Psychotic features in the current episode * Lifetime history of a non-mood-related psychotic disorder * Substance or alcohol abuse/dependence in the past 6 months * Unstable medical disease (e.g., cardiovascular, renal) * Presence of mood cycles of \< 30 days duration * Pregnancy and/or lactation * Presence of a specific contraindication for rTMS (e.g., personal history of epilepsy or convulsion, metallic head implant) * Hearing loss